Ultrasound treatment system

ABSTRACT

An ultrasound treatment system comprises an ultrasonic transducer, a handpiece, a probe, a sheath, a clamping member, an operation unit, an operating member, a suction base, and a perfusion base. The ultrasonic transducer generates ultrasonic vibrations. The handpiece has the ultrasonic transducer incorporated therein. The probe is connected to the ultrasonic transducer for transmitting ultrasonic vibrations to a distal member realizing a stationary portion that is a treatment portion for treating a living tissue. The sheath serves as a protecting member for shielding the probe. The clamping member is opposed to the distal member at the distal end of the sheath for clamping a living tissue in cooperation with the distal member. The operation unit is manipulated for clamping a living tissue with the clamping member and distal member or freeing the living tissue therefrom.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Divisional application of prior application Ser.No. 10/650,759 filed on Aug. 29, 2003; which was a Divisionalapplication of U.S. Ser. No. 09/353,652 filed Jul. 15, 1999, now U.S.Pat. No. 6,669,690; which was a Continuation-In-Part of application ofSer. No. 09/345,794 filed on Jul. 1, 1999, now abandoned; which was adivision of U.S. Ser. No. 08/938,523 filed Sep. 26, 1997, now U.S. Pat.No. 6,056,735; which in turn was a Continuation-In-Part application ofU.S. Ser. No. 08/627,500 filed Apr. 4, 1996, now abandoned.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to an ultrasound treatment system forcoagulating or resecting the region of a living tissue to be treated.

2. Description of the Related Art

In recent years, it has become a matter of common practice that anendoscope is inserted in a body cavity in, order not only to observe anorgan in the body cavity but also to conduct various kinds of curativeprocedures and treatments under the observation through the endoscope.

A means for conducting a curative treatment under endoscopic observationincludes an ultrasound aspiration system that utilizes ultrasonicvibrations for aspiration and an ultrasound knife system that utilizesultrasonic vibrations for incision or the like. Moreover, there is acautery knife system that applies a high-frequency signal to a livingtissue through the tip of a probe for the purpose of incision or thelike.

For example, Japanese Patent Laid-Open No. 62-127042 describes that astone is clamped and crushed by means of ultrasonic vibrations. JapanesePatent Laid-Open 1-232944 describes that a living tissue is clamped andimmobilized using clamp forceps and incised by a probe making ultrasonicvibrations. Japanese Patent Laid-Open No. 1-232945 describes that aliving tissue is sucked for immobilization and then incised by a knifemaking ultrasonic vibrations.

Furthermore, Japanese Patent Laid-Open No. 1-232948 describes thatultrasonic vibrations are imposed on cutting forceps for efficientresection of a living tissue. Japanese Patent Laid-Open No. 1-232949describes similarly to the Japanese Patent Laid-Open No. 1-232944 that aliving tissue is immobilized using a clamping means and then treated bymeans of a treatment member on which ultrasonic vibrations are imposed.U.S. Pat. No. 5,322,055 has proposed an ultrasound surgical applianceshown in FIG. 1. The ultrasound surgical appliance has a holding member991 attached to the tip of a sheath 990 at a point. A bar 992 lyingthrough the sheath 990 is used to cause the holding member 991 to pivot.An ultrasound probe 993 is inserted in the sheath 990 so that theultrasound probe 993 can turn about an axis. The ultrasound probe 993has a knife-like incision area 994 formed on one side of the distalportion thereof, and has a substantially round coagulation surface 995formed on the other side thereof. When the ultrasound probe 993 isturned by manipulating the appliance at a proximal position of theappliance, the incision area 994 or coagulation surface 995 is selected.Thus, the appliance has a composite structure.

To be more specific, for ultrasonic coagulation of a living tissue, asshown in FIG. 1, setting is such that the coagulation surface 995 isoriented toward the holding member 991. The living tissue is clamped bythe holding member 991 and coagulation surface 995 and then subjected toultrasonic coagulation. By contrast, for incising a living tissue,setting is such that the incision area 994 is oriented toward theholding member 991. The living tissue is clamped by the holding member991 and incision area 994 and subjected to ultrasonic incision. Thus,one ultrasound surgical appliance is used to conduct ultrasoniccoagulation and ultrasonic incision selectively.

In the ultrasound surgical appliance, one side of the distal portion ofthe ultrasound probe 993 exposed from the tip of the sheath 990 is thecoagulation surface 995 having a substantially circular and bluntcontour. The opposite side thereof includes the incision area 994 havinga sharp contour suitable for incision. As shown in FIG. 1, duringcoagulation, in particular, since the sharp blade section is oriented ina direction opposite to an object tissue or is facing outward oppositeto the holding member 991, there is a possibility that not only a burnbut also an injury of a tissue by the blade section may occur. Foravoiding these incidents, time-consuming and annoying check work isneeded. This becomes one of causes deteriorating maneuverability.

Moreover, in the ultrasound surgical appliance, the clamp unit andsurgical blade are used to clamp a tissue. This poses problems that aclamped area is limited and sufficient force is not applied to a regionto be cut out.

In particular, for example, as far as a ligament containing lots offibers is concerned, there is a problem that the ligament cannot be cutoff reliably, or a problem that since it takes much time to perfectlycut off the ligament, a surgical blade may dissipate heat very much toburn any other living tissue in contact with the surgical blade.

As far as existing treatment appliances used for a surgical procedureunder endoscopic observation are concerned, a treatment unit used totreat a living tissue is usually located at the distal end of a sheaththat is an insertion unit for inserting the treatment unit into a livingbody, and a manipulating means for use in manipulating the treatmentunit is located at the proximal end of the insertion unit.

In these treatment appliances for surgery under endoscopic observation,a structure, in which as described in DE G92 14059.9 or U.S. Pat. No.5,290,308, an insertion unit and a treatment unit can be turned relativeto a manipulating means, is well-known. According to Japanese PatentLaid-Open No. 6-167728 or DE G91 14 306.3, a frictional means is used toadjust a torque. Japanese Examined Patent Publication No. 5-86223describes that a ball click is used to fix an angle of a turn.

As mentioned above, when an ultrasound treatment appliance is used toclamp a living tissue, it is essential to isolate a probe from a sheathor the like in terms of vibrations because of the presence of atransducer unit. Since there is a structural restriction that the probecannot be turned because the center axis of the probe does not alignwith the center axis of a conveying means, an ultrasound treatmentappliance in which a treatment unit can be turned freely relative to amanipulating means is unavailable. Depending on the situation of aliving tissue, a hand handling a manipulating means may be obliged to betwisted or to handle the manipulating means in any other unnaturalmanner. Thus, the ultrasound treatment appliance still has drawbacksthat must be overcome for practical use.

For resolving these drawbacks, making better approaches to a livingtissue, and improving maneuverability, Japanese Examined Utility ModelPublication No. 6-6809 has revealed that an insertion unit of anultrasound treatment appliance is curved. However, in this appliance,since a handpiece serving as a manipulating means is circular and devoidof directivity, good maneuverability is ensured. In an ultrasoundtreatment appliance having a directive handle as a manipulating means,the aforesaid problems cannot be solved completely.

Furthermore, when an ultrasound treatment appliance is cleaned andsterilized, each component must be cleaned and sterilized with thegreatest care. This work is quite laborious and cumbersome. For omittingthe labor, the appliance may be designed to be disposable. However,there is a problem, which must be solved, concerning the reduction ofmedical expenses, diminishment of polluted wastes, and saving ofresources. If any one part should be broken, the whole appliance wouldhave to be repaired or replaced with a new one.

Furthermore, for example, the first related art described in JapanesePatent Laid-Open No. 60-80446 is an ultrasound surgical system that hasthe capability of a cautery knife so as to crush a living tissue usingultrasonic waves, and that feeds a high-frequency current to a horn at adistal end so as to arrest bleeding through part of a vessel. Byhandling switches, ultrasonic waves can be supplied or a high-frequencycurrent can be fed.

Moreover, for example, the second related art described in JapanesePatent Laid-Open No. 60-227748 is a disclosure of an appliance that is acombination of the capability of an ultrasound knife with that of acautery knife.

In this second related art, an effort is made to wield the outputs ofthe ultrasound and cautery knives simultaneously.

However, the appliance becomes large in size and expensive. The cauteryknife has the hazard of a leakage current. It must be avoided that thehazard is intensified by combining the cautery knife with the ultrasoundknife. Moreover, since the cautery knife and ultrasound knife aredifferent from each other in terms of medical functions and advantages,they may not sometimes be acted simultaneously.

Additionally, the ultrasonic coagulation/incision system disclosed inthe U.S. Pat. No. 5,322,055 oscillates with a living tissue clampedusing the distal part of the probe and the clamping member. Resultantultrasonic vibrations are transmitted to the probe, whereby a livingtissue is coagulated or incised. If a large amount of blood or a fattytissue is present in a surgical region, the blood or fatty tissue may besucked into the sheath shielding the probe.

A driving mechanism for driving the clamping member is incorporated inthe sheath of the ultrasonic coagulation/incision system. When comparedwith an ultrasonic suction apparatus having a very simple intra-sheathstructure, the intra-sheath structure of the ultrasoniccoagulation/incision system is very complex. Once blood or a fattytissue sucked into the sheath adheres to the inside of the probe, it isvery hard to remove the blood or fatty tissue.

When blood or a fatty tissue adheres to the inside of the probe, theimpedance of the probe rises outstandingly. Consequently, the ultrasoniccoagulation/incision system fails to ultrasonically oscillate.Specifically, the impedance characteristic of the probe is disordered,and the resonant frequency of a resonant circuit becomes uncertain. Thisposes a problem in that the ultrasonic coagulation/incision systemcannot ultrasonically oscillate any longer.

In this type of ultrasonic coagulation/incision system, a living tissueto be coagulated and resected is clamped by the distal part of the probeand the clamping member. When the living tissue is clamped andimmobilized, energy of ultrasonic vibrations is converted intofrictional heat. The living tissue is gradually coagulated and thenresected.

At this time, the frictional heat should merely be transmitted to aclamped portion of the living tissue. In practice, however, thefrictional heat is dispersed over a plane on which the living tissue isclamped. There is a fear that a living tissue other than the intendedliving tissue may be affected by the heat.

For example, a nervous tissue is a region in which a problem may stemfrom transmission of heat. It is a matter of common practice that whentreatment is conducted using the foregoing ultrasonic treatmentappliance near the nervous tissue, the ultrasonic treatment appliance isseparated by at least a certain distance from the region.

However, a region that must not be affected by heat may be sunk in afatty tissue or hidden behind a treatment portion. In this case, theregion may not be able to be observed. Furthermore, if a regionsusceptible to heat and the treatment portion are located mutuallyclosely, ultrasonic treatment cannot be conducted. This poses a problemin that usable ultrasonic treatment appliances are limited.

Another problem will be described below. When the probe of theultrasonic coagulation/incision system is vibrated ultrasonically, itmay oscillate at a frequency other than predetermined frequencies(referred to as transverse vibration). In this case, an unbearableabnormal sound may be heard. Furthermore, in this mode, energy causinglongitudinal vibration that is a normal oscillation form is convertedinto energy causing transverse vibration. This leads to a reduction invibrational energy to be applied to the distal end of the probe.Eventually, deterioration in the functions of coagulation and incisionis invited.

Furthermore, when the ultrasonic coagulation/incision system is used,mist is generated from the distal part thereof for clamping a livingtissue and coagulating and for resecting it with ultrasonic vibrations.The mist clouds the interior of a body cavity during a surgicalprocedure under endoscopic observation. This hinders observation of asurgical field. Moreover, the endoscope itself is clouded. This poses aserious problem.

Furthermore, when the ultrasonic coagulation/incision system is used, aslong as a blood vessel to be treated or an organ is exposed to thesurface, no problem occurs. However, the organ may be sunk in a fattytissue or the like, the organ may adhere to another region, or thetreatment portion may be hidden behind a liquid such as blood. In thiscase, the region to be treated must be peeled and exposed beforehand.Various forceps or the like may therefore be used. An ultrasonic suctionapparatus may be used to perform suction or any other treatment bytaking a sufficiently long time. After the region to be treated ispeeled and exposed, the ultrasonic coagulation/incision system is usedto carry out the work of coagulation and hemostasis. However, especiallyin the field of surgery to be conducted under endoscopic observation,the work coagulation and hemostasis brings about the necessity ofputting or removing a plurality of tools using a trocar and cannula.Otherwise, a plurality of operators must work in cooperation with oneanother. This is time-consuming. Since the work cannot be carried oncontinuously, a long time is required for a surgery. Besides, a patientload is enormous.

SUMMARY OF THE INVENTION

Briefly, an ultrasound treatment system of the present inventioncomprises: ultrasonic transducers for generating ultrasonic vibrations;a handpiece having the ultrasonic transducers therein and serving as anoperation unit; a probe connected to the ultrasonic transducers andserving as a vibration conveying member for conveying ultrasonicvibrations to a distal member constituting a stationary section of atreatment unit used to treat a living tissue; a sheath serving as aprotective member for covering the probe; a holding member opposed tothe distal member and constituting a movable section of the treatmentunit for clamping a living tissue in cooperation with the distal member;a manipulating means to be handled for clamping or freeing a livingtissue using the holding member and distal member; an operation memberfor driving the holding member responsively to a movement of themanipulating means; and a turning mechanism for turning the treatmentunit relative to the manipulating means with the axial direction of theultrasonic transducers as a center.

Further, an ultrasound treatment system in accordance with the presentinvention comprises an ultrasonic transducer, a handpiece, a probe, asheath, a clamping member, an operating means, an operating member, asuction base, and a perfusion base. The ultrasonic transducer generatesultrasonic vibrations. The handpiece has the ultrasonic transducerincorporated therein and serves as an operation unit. The probe isconnected to the ultrasonic transducer and transmits ultrasonicvibrations to a distal member realizing a stationary portion that is atreatment portion for treating a living tissue. The sheath serves as aprotecting member for shielding the probe. The clamping member isopposed to the distal member at the distal end of the sheath, andrealizes a movable portion that is another treatment portion forclamping a living tissue in cooperation with the distal member. Theoperating means is manipulated for clamping a living tissue with theclamping member and distal member or freeing the living tissuetherefrom. The suction base is formed on the back end of the handpieceand communicating with a through hole bored substantially along thecenter axes of the probe and ultrasonic transducer. The suction base isformed on the outer circumference of the handpiece and communicatingwith the lumen of the sheath.

OBJECTS OF THE INVENTION

An object of the present invention is to provide an ultrasound treatmentsystem in which a treatment unit of an ultrasound treatment appliancecan turn relative to a manipulating means and the ultrasound treatmentappliance can therefore be used under endoscopic observation or the likewith good maneuverability in the same manner as a surgical appliance.

Another object of the present invention is to provide an ultrasoundtreatment system in which an ultrasound treatment appliance offerssuperb maneuverability and the components of the ultrasound treatmentappliance can be disassembled and assembled readily.

Another object of the present invention is to provide an ultrasoundtreatment system making it possible to conduct both a treatment byultrasonic vibrations and a treatment by a high-frequency currentproperly and readily with safety ensured.

Yet another object of the present invention is to provide an ultrasoundtreatment system making it possible to prevent a treatment member fromtouching a normal tissue unnecessarily, to simplify the work of safetyinspection, to improve the maneuverability for treatments, and to ingeneral conduct surgery safely.

Yet another object of the present invention is to provide an ultrasoundtreatment system capable of incising and coagulating a living tissue andevacuating a crushed tissue out of a body by utilizing an ultrasoniccoagulation/incision function and suction function.

Still another object of the present invention is to provide anultrasound treatment system capable of incising a living tissue readilyand reliably while coagulating it.

A further object of the present invention is to provide an ultrasoundtreatment system for enabling smooth discharge of a living tissue suckedinto a sheath, suppressing a rise in impedance, realizinghigh-efficiency ultrasonic driving, and thus preventing deterioration ina treating ability. Another object of the present invention is toprovide an ultrasound treatment system for confining a coagulated rangeof a living tissue to an intended area, and preventing a nervous tissueor the like from being thermally injured.

Still another object of the present invention is to provide anultrasound treatment system making it possible to uninterruptedly carryout a series of work steps of peeling and exposing a living tissue,emulsifying it, crushing it, sucking it, and discharging it to outside abody at the time of coagulating or incising the living tissue of anintended region.

Still another object of the present invention is to provide anultrasound treatment system contributing to further improvement ofmaneuverability and a drastic reduction in time required for a surgery.

Yet another object of the present invention is to provide an ultrasoundtreatment system capable of incising and coagulating a living tissue andevacuating a crushed tissue out of a body by utilizing an ultrasoniccoagulation/incision function and suction function.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an explanatory diagram showing the structure of a treatmentunit of an ultrasound treatment appliance that is a related art of thepresent invention;

FIG. 2 is an explanatory diagram showing the conceptual configuration ofthe present invention;

FIGS. 3 to 11 are views for explaining the first embodiment of thepresent invention;

FIG. 3 is a plan view showing an ultrasound treatment appliance;

FIG. 4 is a sectional view for explaining the structures of a treatmentunit and insertion unit of the ultrasound treatment appliance;

FIG. 5 is a D1-D2-D3-D4 sectional view of FIG. 4;

FIG. 6 is a view showing the treatment unit in FIG. 4 from the frontthereof;

FIG. 7A is a 7A-7A sectional view of FIG. 4;

FIG. 7B is a 7B-7B sectional view of FIG. 4;

FIG. 7C is a 7C-7C sectional view of FIG. 4;

FIG. 7D is a 7D-7D sectional view of FIG. 4;

FIG. 7E is a 7E-7E sectional view of FIG. 4;

FIG. 7F is a 7F-7F sectional view of FIG. 4;

FIG. 8 is a plan view showing an operation unit;

FIG. 9A is a sectional view of the operation unit;

FIG. 9B is an enlarged sectional view of part of FIG. 9A;

FIG. 10A is a 10A-10A sectional view of FIG. 9A;

FIG. 10B is a 10B-10B sectional view of FIG. 9A;

FIG. 11A is a 11A-11A sectional view of FIG. 9A;

FIG. 11B is a 11B-11B sectional view of FIG. 9A;

FIG. 11C is a 11C-11C sectional view of FIG. 9A;

FIG. 11D is a 11D-11D sectional view of FIG. 9A;

FIGS. 12A and 12B are view for explaining the second embodiment of thepresent invention;

FIG. 12A is a side view for explaining the structure of a treatment unitof an ultrasound treatment appliance;

FIG. 12B is a front view for explaining the structure of the treatmentunit of the ultrasound treatment appliance;

FIGS. 13A and 13B are views for explaining the third embodiment of thepresent invention;

FIG. 13A is an oblique view of a treatment unit of an ultrasoundtreatment appliance;

FIG. 13B is an explanatory view showing a meshing side of a holdingmember constituting the treatment unit;

FIG. 14 is a sectional view showing part of an insertion unit in thefourth embodiment of the present invention;

FIG. 15 is an oblique view showing the structure of an treatment unit inthe fifth embodiment of the present invention;

FIG. 16 is a sectional view showing the structure of part of aninsertion unit in the sixth embodiment of the present invention;

FIGS. 17A and 17B are views for explaining the seventh embodiment of thepresent invention;

FIG. 17A is an oblique view showing a bearing and ball click mechanismof a manipulating means;

FIG. 17B is a sectional view for explaining a ball click and an elasticmember;

FIGS. 18 and 19 are views for explaining the eighth embodiment of thepresent invention;

FIG. 18 is a sectional view showing the structure of an operation unit;

FIG. 19 is an oblique view showing the structure of a bearing of theoperation unit;

FIGS. 20 to 25 are views for explaining the ninth embodiment of thepresent invention;

FIG. 20 is a plan view showing an ultrasound treatment appliance of thisembodiment;

FIG. 21A is a sectional view showing part of a probe including atreatment unit of the ultrasound treatment appliance;

FIG. 21B is a sectional view showing part of the treatment unit;

FIG. 22A is a 22A-22A sectional view of FIG. 21A;

FIG. 22B is a 22B-22B sectional view of FIG. 21A;

FIG. 22C is a 22C-22C sectional view of FIG. 21A;

FIG. 22D is a 22D-22D sectional view of FIG. 21A;

FIG. 23 is a sectional view showing an insertion unit of an ultrasoundtreatment appliance;

FIG. 24 is a sectional view showing an operation unit;

FIG. 25A is a 25A-25A sectional view of FIG. 24;

FIG. 25B is a 25B-25B sectional view of FIG. 24;

FIG. 25C is a 25C-25C sectional view of FIG. 24;

FIG. 26 is a plan view showing an ultrasound treatment appliance of thetenth embodiment of the present invention;

FIGS. 27 to 39 are views for explaining the eleventh embodiment of thepresent invention;

FIG. 27 is an oblique view showing the outline configuration of theultrasound treatment appliance;

FIG. 28 is an oblique view showing the ultrasound treatment appliance ina state in which a sheath is detached from an operation unit;

FIG. 29 is an oblique view showing the ultrasound treatment appliance ina state in which a vibration conveying rod and rotor are dismounted fromthe sheath;

FIG. 30 is a view for explaining an example of a method of locking therotor in the operation unit;

FIG. 31 is a view for explaining another method of locking the rotor inthe operation unit;

FIG. 32 is a view for explaining another method of locking the rotor inthe operation unit;

FIG. 32A is a view showing a stage before the rotor is locked in theoperation unit;

FIG. 32B is a view showing a state in which the rotor is locked in theoperation unit;

FIG. 33 is a view for explaining an example of finishing the surface ofa distal member constituting a treatment unit;

FIG. 34A is a view for explaining another example of finishing thesurface of the distal member constituting the treatment unit;

FIG. 34B is a view for explaining another example of finishing thesurface of the distal member constituting the treatment unit;

FIG. 35 is a view for explaining another shape of the distal memberconstituting the treatment unit;

FIG. 36A is a view for explaining a structure of coupling couplingmembers with a vibration conveying rod;

FIG. 36B is a view for explaining the positions of ditches on thevibration conveying rod;

FIG. 37 is a view for explaining a structure for coupling the couplingmembers with the vibration conveying rod;

FIG. 38A is an explanatory view showing the structure of junctions forcoupling the distal member, vibration conveying rod, and horn;

FIG. 38B is a view showing a state in which the distal member andvibration conveying rod are coupled with each other;

FIG. 38C is a view showing another structure of the junctions forcoupling the distal member, vibration conveying rod, and horn;

FIG. 39A is a view showing a structure in which a transducer unit and atransducer cover constituting an operation unit are separate bodies;

FIG. 39B is a view showing a structure in which the transducer unit andtransducer cover constituting the operation unit are united;

FIGS. 40 to 43 are views for explaining the twelfth embodiment of thepresent invention;

FIG. 40 is an explanatory view showing the structure of an ultrasoundtreatment appliance;

FIG. 41 is an oblique view for explaining the structure of a treatmentunit of the ultrasound treatment appliance;

FIG. 42 is a view for explaining the turning relationship of a holdingmember and a sheath relative to a distal member;

FIG. 43 is a view for explaining the turning relationship of the holdingmember, sheath, and protective tube relative to the distal member;

FIGS. 44 to 46 are views for explaining the thirteenth embodiment of thepresent invention;

FIG. 44 is an oblique view showing an ultrasound treatment appliance;

FIG. 45 is an explanatory view showing the inner structure of a sheath;

FIG. 46A is a view showing the structure of FIG. 45 from the frontthereof;

FIG. 46B is a 46B-46B sectional view of FIG. 45;

FIGS. 47 to 49 are explanatory diagrams showing the fourteenthembodiment of the present invention;

FIG. 47 is an explanatory diagram showing the overall configuration ofan ultrasound treatment system;

FIG. 48 is an explanatory diagram showing an ultrasound treatmentappliance and the electrical configuration of a driving system for theultrasound treatment appliance;

FIG. 49 is a diagram for explaining in detail the configuration of adrive unit;

FIGS. 50 and 51 are a diagram and view for explaining the fifteenthembodiment of the present invention;

FIG. 50 is an explanatory diagram showing the overall configuration ofan ultrasound treatment system;

FIG. 51 is an oblique view showing a treatment unit of an ultrasoundtreatment appliance;

FIG. 52 is an explanatory diagram showing the overall configuration ofan ultrasound treatment system of the sixteenth embodiment of thepresent invention;

FIGS. 53 to 58 are views for explaining the seventeenth embodiment ofthe present invention;

FIG. 53 is an explanatory view showing the structure of an ultrasoundtreatment appliance;

FIG. 54 is a sectional view for explaining the distal portion of aninsertion unit of the ultrasound treatment appliance and a treatmentunit thereof;

FIG. 55 is a 55-55 view of FIG. 54;

FIG. 56 is a 56-56 view of FIG. 54;

FIG. 57 is a sectional view for explaining the proximal portion of aninsertion unit of the ultrasound treatment appliance and an operationunit thereof;

FIG. 58 is an explanatory diagram showing the circuitry of an ultrasoundtreatment system;

FIG. 59 is a diagram for explaining the connecting relationship betweenan ultrasound treatment appliance and power supplies;

FIG. 60 is a diagram for explaining another example of the connectingrelationship between an ultrasound treatment appliance and powersupplies;

FIG. 61 is a diagram for explaining another example of the connectingrelationship between an ultrasound treatment appliance and a powersupply;

FIG. 62 is a diagram for explaining yet another example of theconnecting relationship between an ultrasound treatment appliance and apower supply;

FIGS. 63 to 65 are views for explaining the eighteenth embodiment of thepresent invention;

FIG. 63A is a view showing a state in which a probe is inserted in asheath;

FIG. 63B is a view showing a state in which the probe is mounted at agiven position in the sheath;

FIG. 64 is a sectional view for explaining the structure of a treatmentsection of an ultrasound treatment appliance;

FIG. 65 is a view for explaining a use state of the ultrasound treatmentappliance;

FIG. 66 is a sectional view for explaining the structure of a treatmentsection of an ultrasound treatment instrument of the nineteenthembodiment of the present invention;

FIG. 67 is a sectional view showing a treatment section of an ultrasoundtreatment appliance of the twentieth embodiment of the presentinvention;

FIG. 68 is an explanatory diagram showing the outline configuration ofan ultrasound treatment system of the twenty-first embodiment of thepresent invention;

FIG. 69 is an explanatory diagram showing the outline configuration ofan ultrasound treatment system of the twenty-second embodiment of thepresent invention;

FIGS. 70A and 70B are diagrams for explaining the twenty-thirdembodiment of the present invention;

FIG. 70A is a diagram for explaining a state before ultrasonicoscillations occur;

FIG. 70B is a diagram showing a state in which ultrasonic oscillationsoccur;

FIG. 71 is a sectional view for explaining the structure of a treatmentsection of an ultrasound treatment appliance of the twenty-fourthembodiment of the present invention;

FIGS. 72 to 74 are views showing the twenty-fifth embodiment of thepresent invention;

FIG. 72 is a plan view showing an ultrasound treatment appliance;

FIG. 73 is a view showing the structure of a treatment unit of theultrasound treatment appliance;

FIG. 74 is a diagram for explaining the shapes of a holding member anddistal member constituting the treatment unit; and

FIG. 75 is a diagram showing the structure of a treatment unit of anultrasound treatment appliance of the twenty-sixth embodiment of thepresent invention.

FIG. 76 is a view showing the overall configuration of an ultrasoundtreatment system of the twenty-seventh embodiment of the presentinvention.

FIG. 77 to FIG. 84 are diagrams for explaining the twenty-eighthembodiment of the present invention;

FIG. 77 is an oblique view showing a handpiece of an ultrasonicincision/coagulation system of the twenty-eighth embodiment;

FIG. 78A is an oblique view showing an internal unit of the handpiece ofthe ultrasonic incision/coagulation system;

FIG. 78B is an oblique view showing an external unit of the ultrasonicincision/coagulation system;

FIG. 79A is a longitudinal sectional view showing the distal part of theinternal unit included in the handpiece of the ultrasonicincision/coagulation system;

FIG. 79B is a 79B-79B sectional view of the distal part shown in FIG.79A;

FIG. 79C is a 79C-79C sectional view of the distal part shown in FIG.79A;

FIG. 80 is a diagram for explaining a clamping member driving mechanismand a probe included in the internal unit of the handpiece of theultrasonic incision/coagulation system;

FIG. 81A is a longitudinal sectional view showing major componentslocated near a stationary handle included in the external unit of thehandpiece of the ultrasonic incision/coagulation system;

FIG. 81B is a 81B-81B sectional view of the major components shown inFIG. 81A;

FIG. 82 is an oblique view showing a treatment portion of the handpieceof the ultrasonic incision/coagulation system;

FIG. 83A is a front view showing a closed state of a clamping memberthat is the treatment portion of the handpiece of the ultrasonicincision/coagulation system;

FIG. 83B is a front view showing a closed state of the clamping memberthat is the treatment portion;

FIG. 84 shows the overall configuration of an ultrasonicincision/coagulation system;

FIG. 85 is an oblique view showing a handpiece of the ultrasonicincision/coagulation system in accordance with the twenty-ninthembodiment of the present invention;

FIG. 86 is an oblique view showing a treatment portion of a handpiece ofan ultrasonic incision/coagulation system in accordance with thethirtieth embodiment of the present invention; and

FIG. 87 is an oblique view showing a treatment portion of a handpiece ofan ultrasonic incision/coagulation system in accordance with thethirty-first embodiment of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

As shown in FIG. 2, an ultrasound treatment system 99 provides superbmaneuverability for the treatment of a living body by means ofultrasonic vibrations or a cautery knife, and includes an ultrasoundtreatment appliance 31 whose components can be disassembled or assembledreadily, and a drive unit 90. The ultrasound treatment applianceincludes ultrasonic transducers 50, and a probe for conveying ultrasonicvibrations to a distal portion for the purpose of a treatment such ascoagulation. A driving signal is applied from a drive circuit 94 in thedrive unit 90 to the ultrasonic transducers 50. The application of thedriving signal brings about ultrasonic vibrations.

A cautery knife signal can be applied from a cautery knife unit 91 tothe probe 8, whereby a treatment by a cautery knife can be conducted.

A sense circuit 92 for sensing whether or not a cautery knife signal ispresent on a line over which a cautery knife signal is transmitted isincluded in the drive unit 90. An output of the sense circuit 92 isoutput to a control circuit 93. When a cautery knife signal is detected,the control circuit 93 gives the alarm to an operator or nurse through,for example, a speaker 95, notifies them of the fact using a display 96,and switches off the drive circuit 94 so that a driving signal sent fromthe drive circuit 94 will not be output to the ultrasonic transducers50. By contrast, when a cautery knife signal is not detected, the drivecircuit 94 is switched on so that the driving signal will be output tothe ultrasonic transducers 50.

Thus, an on-off operation of supply of a driving signal is performedaccording to a result of detection of a cautery knife signal. Atreatment by ultrasonic waves and a treatment by a cautery knife cantherefore be conducted selectively. It can be prevented that both theultrasonic transducers and cautery knife are driven simultaneously bymistake. Safety can be ensured.

Referring to FIGS. 3 to 11, the first embodiment of the presentinvention will be described.

As shown in FIG. 3, an ultrasound treatment appliance 31 of the firstembodiment of the present invention includes an insertion unit 57 havinga treatment unit 33, which is used to conduct a treatment, attached to adistal end thereof, and a manipulating means 34 formed at the proximalend of the insertion unit 57 and used to manipulate the treatment unit33. The insertion unit 57 has an insertion unit armor formed with anelongated sheath 9 so that the insertion unit 57 can be inserted in aliving body.

At the upper proximal end of the manipulating means 34, a sheath 22whose diameter is larger than that of the sheath 5 is located. Ahandpiece 32, which supplies ultrasonic vibrations used for incision andcoagulation to the treatment unit 33, includes ultrasonic transducers 50shown in FIG. 9A, and serves as a transducer unit, is formed at theproximal end of the sheath 22.

As shown in FIG. 4, the sheath 9 constituting the insertion unit 57 has,for example, two independent upper and lower channels which areprotected by the sheath 9. A forceps unit 58 serving as a treatmentinstrument used to conduct a treatment of incision and coagulation liesthrough the upper channel. A probe 8 serving as a vibration conveyingmember for conveying ultrasonic vibrations stemming from the ultrasonictransducers 50 in the handpiece 32, and a distal member 7 screwed to thedistal end of the probe 8 so that the distal member 7 will be freelydetachable are inserted in the lower channel.

The treatment unit 33 and insertion unit 57 have structures shown inFIGS. 4 to 7F.

A movable member, which conveys manipulation force applied by themanipulating means 34, can advance and withdraw freely, and is shapedsubstantially like a cylinder, is inserted in a pipe-like armor memberof the forceps unit 58. Moreover, a holding member 1 that clamps orfrees a living tissue in cooperation with the distal member 7 located atthe distal end of the probe 8 is attached to a movable section 3 that isthe distal portion of the forceps unit 58 by a screw 2. That is to say,as shown in FIG. 6, the bottom of the holding member 1 and the top ofthe distal member 7 are shaped substantially like planes. The planesclamp or free a living tissue.

As shown in FIG. 5, coagulation ditches 61 that are transverse ditchesextending transversely are formed on the bottom plane of the holdingmember 1 so that a tissue can be held reliably to facilitatecoagulation.

As shown in FIGS. 4 and 5, the movable section 3 is supported at thedistal end of a first operation member 5 serving as an operation memberof the forceps unit 58 so that the movable section 3 can freely pivotwith a pin 35 as a center. The movable section 3 pivots about the pin 35as a center in relation to the advancement and withdrawal of a pin 36fitted in an elongated hole.

A coupling member 41 is screwed tightly to the proximal end of the firstoperation member 5. The distal end of a second operation member 10 isscrewed tightly to the coupling member 41. The proximal end of thesecond operation member 10 is jutting out proximally from the proximalend of the sheath 9 constituting the insertion unit 57. The distal endof an engaging member 42 is connected to the jutting proximal end of thesecond operation member 10 by means of a screw. In other words, thefirst operation member 5 constituting the forceps unit 58 is coupledwith the second operation member 10, which is proximal to the firstoperation member 5, and the engaging member 42, which is proximal to thesecond operation member 10, using screws, so that these components canbe disassembled and assembled.

A spherical section 43 is formed at the proximal end of the engagingmember 42. The spherical section 42 is held by an upper lockingmechanism of a movable manipulation handle 30 constituting themanipulating means 34 shown in FIGS. 3 9A, and 9B so that the sphericalsection 43 can advance or withdraw in a direction of the axis of theinsertion unit 57. With the opening or closing of the movablemanipulation handle 30, the engaging member 42, second operation member10, and first operation member 5 are driven to advance or withdraw.Consequently, as mentioned above, the movable section 3 can be opened orclosed.

A sheath 11 constituting an armor member of the forceps unit 58 has theproximal end thereof joined or coupled with a pipe 14 together with anouter sheath 10 thereof via a joining member 13 at a position inside aknob 12. The pipe 14 is mounted in a stationary manipulation handle 29serving as a stationary manipulation member of the manipulating means34.

The holding member 1 and screw 2 are molded using an insulating materialsuch as a resin in case consideration is, as mentioned later, taken intoa treatment to be conducted by feeding a high-frequency current. In anyother case, the holding member 1 and screw 2 may be molded using a metalor the like.

As shown in FIGS. 4 and 5, a meshing member 37 shaped substantially likea cylinder is inserted in the upper channel of the sheath 9 throughwhich the forceps unit 58 lies. A jut 39 jutting out radially internallyis formed on the inner circumference of the proximal end of the meshingmember 37. A snap-fit 38 formed at the proximal end of a distal cover 6is engaged with the jut 39. When the snap-fit 38 of the distal cover 6is pushed proximally beyond the jut 39, the snap-fit 38 and jut 39 canbe engaged with each other. Consequently, the forceps unit 58 can belocked in the sheath 9. By strongly pulling the forceps unit 58 towardthe distal end of the sheath 9, the snap-fit 38 and jut 39 aredisengaged from each other. Consequently, the forceps unit 58 and sheath9 can be disassembled; that is, the forceps unit 58 can be dismountedfrom the sheath 9.

At this time, if the holding member 1 is opened even slightly, theposition of the coupling member 41 advances so that the distal end ofthe coupling member 41 will invade into the snap-fit 38. This invasiondisables the snap-fit 38 from swaying in an inner circumferentialdirection. The forceps unit 58 cannot therefore be dismounted from thesheath 9.

In other words, for dismounting the forceps unit 58, the holding member1 must be perfectly closed relative to the distal member 7. When theholding member 1 is not perfectly closed, for example, when the holdingmember 1 is used to clamp a living tissue in practical use, there is notthe hazard that the forceps unit 58 may come off. The forceps unit 58and sheath 9 can be disassembled or assembled each other with safetyensured.

At this time, since an anti-turn mechanism 40 is formed as a structurein which the portions of the meshing member 37 and distal cover 6 whichengage with each other do not attain rotation symmetry, for example, astructure in which the position of the distal end of a stepped plane,which is formed on the outer circumference of the distal cover 6 so thatthe stepped plane can be engaged with the meshing member 37, varies in acircumferential direction of the distal cover 6, it can be preventedthat the forceps unit 58 turns relative to the sheath 9. Moreover, aproblem that when a living tissue is clamped, an unexpected turn occursto deteriorate maneuverability.

The proximal end of the meshing member 37 is coupled with the sheath 11lying in the sheath 9.

The probe 8 tightly screwed to the proximal end of the distal member 7and designed to convey ultrasonic vibrations stemming from theultrasonic transducers 50 to the distal member 7 is inserted in thelower channel of the sheath 9. The upper part of the distal end of thedistal member 7 is a plane as shown in FIG. 7A, so that the distalmember 7 can readily clamp a living tissue in cooperation with theholding member 1. The upper plane of the distal member 7 extends, asshown in FIGS. 7B and 7C, proximally farther than the holding member 1.The sectional shape of the portion of the distal member 7 proximallyfarther than the holding member 1 is, as shown in FIGS. 7D to 7F,circular.

The distal apex of the distal member 7 is molded substantially conicallyand jutting out distally farther than the holding member 1. This portionof the distal member 7 is used for ablation. The distal member 7 isfreely detachable from the distal end of the probe 8 after beingscrewed. The holding member 1 is also freely detachable from the movablesection 3 by means of the screw 2. The distal member 7 and holdingmember 1 can therefore be freely replaced with another ones. Thus, thedistal member 7 and holding member 1 having optimal shapes can be put touse.

As shown in FIG. 4, a protective member 4 that is resistive to heat anddurable to ultrasonic vibrations; such as, a member madeofplytetrafluoroethylene (PTFE) or ceramic is located in a distal boreof the lower channel of the sheath 9. Owing to the protective member 4,it can be prevented that when a living tissue is clamped, if the distalmember 7 reacts to bend downward, the distal member 7 and sheath 9 comeinto contact with each other to break.

FIGS. 8 to 11D show the manipulating means 34. The manipulating means 34is located at the proximal end of the insertion unit 57. The sheath 9and joining member 13 are attached to the manipulating means 34. Thedistal portion of the pipe 14 is attached to the outer circumference ofthe joining member 13. A knob 12 is engaged with the outer circumferenceof the distal portion of the pipe 14, and joined or fixed with or to theouter circumference thereof by a screw 44.

By loosening the screw 44, the knob 12 can be removed toward the distalend of the sheath 9. As described later, the sheath 9, pipe 14, andsheath 22 which constitute a sheath assembly can be disassembled orassembled relative to the manipulating means 34.

The pipe 14 lies through a first bearing 15 and second bearing 19 whichare attached to the tops of the front and back portions of thebifurcating stationary manipulation handle 29. The pipe 14 is supportedby the first bearing 15 and second bearing 19 which are fixed to thestationary manipulation handle 29 so that the pipe 14 will be freelyturnable. An O ring 45 and two O rings 47 are placed on slidableinterfaces between the outer circumference of the pipe 14 and the innercircumferences of the first bearing 15 and second bearing 19, thusrestricting sliding at least in a circumferential direction and, in thisembodiment, in a back-and-forth direction. Consequently, the magnitudeof a torque for the pipe 14 relative to the bearing 15 or bearing 19 ismade adjustable.

When the knob 12 is held and turned, the pipe 14 turns together with theknob 12 relative to the first bearing 15 and second bearing 19. Theprobe 8 lies through along the center axis of the pipe 14, while theforceps unit 58 lies through the sheath 9 off the center axis of thepipe 14. The forceps unit 58 is therefore turned about the center axisof the probe 8 which is aligned with the center axis of an ultrasonictransducers 50.

As apparent from FIG. 9 or the like, the center axis of the sheath 9 isnot aligned with the center axis of the probe 8. When the knob 12 isturned, the insertion unit 57 having the treatment unit 33 attached tothe distal end thereof or the sheath 9 turns in a decentered mannerresponsively to the turn of the pipe 14.

As also shown in FIGS. 10A and 10B, the probe 8 coaxially lies throughthe cylindrical pipe 14 along the center axis of the pipe 14. Theproximal end of the probe 8 is coupled with a vibration driving axis ofthe ultrasonic transducers 50, which generate ultrasonic waves and liein the handpiece 32 that has a cylindrical outer circumference engagingwith the cylindrical sheath 22 and that can slide freely, via a couplingmember, for example, a screwing member. Thus, these components can bedisassembled or assembled one another.

The pipe 14 has, as shown in FIG. 8, an elliptic ditch 55, which isbored vertically and elongated back and forth, formed on a portionthereof between the first bearing 15 and second bearing 19. Drivingmembers 16 and 17 (See FIGS. 9 and 1 OB) that are each shapedsubstantially like a semi-disk are fitted vertically into the ditch 55so that the driving members can freely move back and forth. The drivingmembers 16 and 17 are then, as shown in FIG. 10B, joined with each otherby screws 53. The driving members 16 and 17 drive the engaging member 42so that the engaging member 42 can advance or withdraw. As mentionedabove, when the operation members 10 and 5 are driven to advance orwithdraw, the holding member 1 is opened or closed.

The engaging member 42 that is decentered and terminated at the middleof the pipe 14 is locked in a state in which the spherical section 43formed at the proximal end of the engaging member 42 is fitted in anengagement ditch formed radially in the driving member 16 mounted on thetop of the variable manipulation handle 30.

A joining member 20 is attached to the proximal portion of the pipe 14by a screw 46 which joins the joining member 20 with the pipe 14 so thatthey can be disassembled or assembled each other. The sheath 22 in whichthe handpiece 32 is fitted is attached to the outer circumference of theproximal end of the joining member 20 by a screw 49. A thread is formedon the outer circumference of the proximal portion of the sheath 22. Aring 23 is mounted and engaged with the thread.

A backup ring 24 and an O ring 59 are stowed under the innercircumference of the ring 23. By turning the ring 23 in a direction inwhich the ring 23 is tightened to the operation unit sheath 22, the Oring 59 is compressed to stress the outer circumference of the handpiece32. Thus, the handpiece 32 can be fixed to the sheath 22.

Owing to the foregoing structure, the handpiece 32 can be advanced orwithdrawn relative to the sheath 22 by turning the ring 23 in a freeingdirection. A quantity of jutting out the distal member 7 of thetreatment unit 33 can be adjusted by advancing or withdrawing thehandpiece 32. For example, therefore, a treatment can be conducted bysetting a quantity of jutting-out suitable for the treatment of anobject tissue. When the distal member 7 is replaced with another one tobe used actually, a quantity of jutting-out suitable for a treatment canbe set properly.

The handpiece 32 is provided with a guide sheath 21 extending distally.An O ring 48 is placed on the outer circumference of the distal end ofthe guide sheath 21. The guide sheath 21 and joining member 20 are thussealed up.

A pipe 18 is used to link the joining member 13 and joining member 20 inorder to shut off a channel, through which the portion of the probe 8interposed between the joining member 13 and joining member 20 lies,from the outside. Thus, a sealed channel is constructed.

When a treatment is, as described later, conducted by feeding ahigh-frequency current to the probe 8, if the sheath 9, joining member13, joining member 20, pipe 18, and guide sheath 21 are molded using aninsulating material such as PTFE or polysulfone, safety can be ensuredwithout the necessity of concerning about a leakage of a high-frequencycurrent.

Owing to the foregoing structure, the forceps unit 58 and probe 8 areperfectly isolated from each other. When the forceps unit 58 is providedwith a connector for connection, or a high-frequency current is feddirectly, a living tissue can be treated by, for example, feeding ahigh-frequency current to the movable section 3 and distal member 7selectively or by feeding the high-frequency current to both of them.Besides, a treatment can be conducted in a bipolar state in which ahigh-frequency current flows through a living tissue between both themovable section 3 and distal member 7.

In this case, it is recommended that the bare side of each of thedriving member 16 driving member 17, stationary manipulation handle 29,movable manipulation handle 30, engaging member 42, bearing 15, bearing19, sheath 22, and ring 23 be painted with an electrically insulatingmaterial, for example, PTFE in order to prevent a high-frequency currentfrom flowing into an operator.

The channel through which the probe 8 lies and the channel proximal tothe probe 8 are formed as sealed channels. Using the gap between thechannels and the circumference of the probe 8, a channel through which afluid can be passed for perfusion, aspiration, or the like by means of aperfusion/aspiration unit, which is not shown, connected to aperfusion/aspiration base 51 formed at the proximal end of the handpiece32 can be realized. Bleeding blood can therefore be aspirated anddischarged outside during, for example, incision.

A junction for a cord 52 is formed at the proximal end of the handpiece32. Through the junction, a driving signal for triggering ultrasonicvibrations is applied from the drive unit 90 to the ultrasonictransducers 50 over the cord 52.

As described previously, the engaging member 42 is screwed tightly tothe proximal end of the conveying member 10 penetrating the upperchannel of the sheath 9. The spherical section 53 is formed at theproximal end of the engaging member 42. As shown in FIG. 10B, thespherical section 43 meshes with the engagement ditch of the drivingmember 16.

An engagement ditch 56 is formed circumferentially along the outercircumferences of the driving members 16 and 17. Driving pins 25 arefitted into the engagement ditch 56 at right-hand and left-handpositions. When the driving pins 25 move back and forth, the drivingmembers 16 and 17 also move back and forth. The driving pins 25 aresupported by both edges of a semicircular driving member 26. The bottomof the driving member 26 is joined with the top of the movablemanipulation handle 30 by a screw 54.

The movable manipulation handle 30 and stationary manipulation handle 29are joined by screws 27 and 28 so that the movable manipulation handle30 can pivot freely.

When a manipulation is made to move the movable manipulation handle 30back and forth relative to the stationary manipulation handle 29, thespherical section 43 moves back and forth via the driving pins 25 anddriving members 16 and 17. Eventually, the holding member 1 of theforceps unit 58 can be opened or closed.

Specifically, when a finger rest formed as a lower part of the movablemanipulation handle 30 is opened or closed, the driving member 26advances or withdraws with the screw 27 as a supporting point. Thiscauses the driving pins 25 to advance or withdraw. With the advancementor withdrawal of the driving pins 25, the driving members 16 and 17advance or withdraw. The conveying member 10, coupling member 41, andconveying member 5 then advance or withdraw. This causes the movablesection 3 to open or close as mentioned above. Eventually, the holdingmember 1 opens or closes.

When the knob 12 is turned relative to the manipulating means 34, thehandpiece 32 turns in an interlocked manner. As a result, the treatmentunit 33 can be turned relative to the manipulating means 34. Owing tothis structure, an orientation in which a living tissue is clamped canbe varied. Thus, the maneuverability for treatments is improved.

That is to say, when the treatment unit 33 is turned as mentioned above,the driving member 16 and driving member 17 are turned simultaneously.Since the outer circumferences of the driving members are circular andengaged with the driving pins 25 in the circular engagement ditch 56,the treatment unit 33 can be turned 360.degree. relative to themanipulating means 34 without any problem.

Next, the actual procedure of using this embodiment will be described.

First, the ultrasound treatment appliance 31 is opposed to a livingtissue to be treated. The orientation of the treatment unit 33 ismatched with an orientation permitting smooth treatment by turning theknob 12. At this time, as mentioned above, the torque can be adjusted toan appropriate level by means of the O ring 45 and O ring 47. The torqueis set to the level that allows the knob 12 to turn when a turn isneeded but that does not permit a careless turn.

The movable manipulation handle 30 is then manipulated in an opendirection in order to open the holding member 1. The object livingtissue is interposed between the holding member 1 and distal member 7.The movable manipulation handle 30 is then closed so that the livingtissue can be clamped by the holding member 1 and distal member 7.

By manipulating a foot switch or the like that is not shown, a drivingsignal is applied from the driving power supply for the ultrasonictransducers 50 to the ultrasonic transducers 50. The ultrasonictransducers 50 are then excited. The resultant ultrasonic vibrations areconveyed from the probe 8 to the distal member 7, and given to theclamped living tissue through the distal member 7. The clamped livingtissue is heated with frictional heat until the living tissue has a hightemperature, whereby coagulation or incision can be achieved. At thistime, a living tissue can be incised or coagulated readily by optimizinga time and amplitude during and with which ultrasonic vibrations aregiven to a living tissue as well as a quantity of force with which theliving tissue is clamped.

For example, the time is extended, the amplitude is increased, and theclamping force is intensified. The thus-set factors are convenient forincision. The opposite setting is convenient for coagulation.

When a living tissue is merely clamped, as mentioned above, the livingtissue can be clamped by the distal member 7 and holding member 1.

For ablating a living tissue, the holding member 1 is closed or opened.The substantially conical section of the distal end of the distal member7 is used to perform ablation bluntly. Alternatively, ablation may beconducted by imposing ultrasonic vibrations as mentioned above.

Furthermore, even when ultrasonic vibrations are imposed with the distalmember 7 alone pressed to a living tissue, the living tissue can beincised or coagulated.

When a treatment using a high-frequency current is required, ahigh-frequency current is supplied from a high-frequency power supplythat is not shown to the handpiece 32, and then fed from the handpiece32 to the distal member 7 via the ultrasonic transducers 50.

Thus, a high-frequency current is fed to a living tissue through thedistal member 7. Similarly to the aforesaid procedure using ultrasonicvibrations, the living tissue can be ablated, incised, or coagulated bythe high-frequency current. At this time, as mentioned above, thechannels of the probe 8 and of the forceps unit 58 are isolated fromeach other perfectly. Furthermore, the holding member 1 is molded withan insulating member. A treatment by a high-frequency current cantherefore be achieved safely and efficiently without a high-frequencycurrent leakage.

Moreover, a treatment by ultrasonic vibrations and a treatment by ahigh-frequency current may be conducted in combination if necessary.

Next, the procedure of disassembling or assembling the components of theultrasound treatment appliance of this embodiment will be described.

First, the two screws 53 for joining the driving members 16 and 17located on the movable manipulation handle 30 are removed from theultrasound treatment appliance 31 shown in FIG. 3 in an assembled state.The driving members 16 and 17 are detached up and down from the pipe 14.The spherical section 43 is disengaged from the engagement ditch of thedriving member 16. This makes it possible to free the proximal portionof the forceps unit 58.

Next, the holding member 1 is closed perfectly relative to the distalmember 7, and pulled distally away from the sheath 9. This pullingcauses the snap-fit 38 to sway in an inner circumferential direction andget over the jut 39. The forceps unit 58 can now be disassembled fromthe sheath 9.

The ring 23 located at the proximal end of the sheath 22 is then turnedin a freeing direction in order to loose the joined state between thehandpiece 32 and sheath 22. The handpiece 32 is then pulled out behindthe manipulating means 34. This pulling makes it possible to dismountthe handpiece 32 backward from the insertion unit 57 and manipulatingmeans 34 together with the probe 8.

Thereafter, the probe 8 is turned relative to the handpiece 32 and thusunscrewed from the handpiece 32. The probe 8 is then dismounted from thehandpiece 32. By performing unscrewing in the same manner, the distalmember 7 is dismounted from the probe 8.

For disassembling the insertion unit 57 and manipulating means 34, thescrew 44 of the knob 12 is removed from the knob 12, and then the knob12 is dismounted from the distal portion of the sheath 9. A unitcomposed of the sheath 9, pipe 14, and sheath 22 is pulled out backwardfrom the manipulating means 34, and thus dismounted from the drivingmember 26, movable manipulation handle 30, and stationary manipulationhandle 29.

The foregoing series of operations brings the ultrasound treatmentappliance 31 to a state in which the respective parts can be fullycleaned and sterilized. By removing the screw 54 for joining the drivingmember 26 with the movable manipulation handle 30, the driving member 26and movable manipulation handle 30 can be disassembled.

By disassembling the screws 27 and 28, the stationary manipulationhandle 29 and movable manipulation handle 30 can be disassembled. Theguide sheath 21 and handpiece 32 can be disassembled by unscrewing.

The thus-disassembled members are cleaned and sterilized. After thecleaning and sterilization are completed, the components are assembledagain by reversing the foregoing sequence. The ultrasound treatmentappliance 31 is then constructed.

Since the structure permits disassembling and assembling as mentionedabove, the disassembled components can be fully or reliably cleaned andsterilized without labor. If any member should be broken, the memberalone would have to be replaced with a new one. The use of theultrasound treatment appliance can be continued uninterruptedly. This iseconomic.

Furthermore, the forceps unit 58 is coupled with the proximal conveyingmember 10 by tightening a screw. When the forceps unit 58 is replacedwith another one, another forceps unit 58 having a different shape orsize suitable for a treatment can be used to conduct a treatment.Moreover, since the distal member 7 of the probe 8 can be disassembledor assembled freely, another distal member 7 having a different shape orsize can be used for a treatment.

Referring to FIGS. 12A and 12B, the second embodiment of the presentinvention will be described.

FIGS. 12A and 12B show a major portion of the second embodiment of thepresent invention. This embodiment has substantially the same structureas the first embodiment. However, this embodiment aims mainly atincision of a living tissue, and is therefore devoid of the holdingmember 1. Instead, the distal end of the movable section 3 and thedistal member 7 constitute scissors. A living tissue can therefore beincised efficiently and safely.

The other components are identical to those in the first embodiment. Inthis embodiment, the distal end of the movable section 3 and the tip ofthe distal member 7 are pressed against a living tissue to be incised.The movable section 3 is then moved from an open state in a closingdirection, whereby ultrasonic vibrations are imposed on the livingtissue in contact with the scissors. Thus, the living tissue can beresected.

In short, this embodiment provides the ability to resect or incise aliving tissue by pinching it using scissors instead of the ability ofthe first embodiment to at least incise or coagulate a living tissue byclamping it. Similarly to the first embodiment, the knob 12 that is notshown in FIGS. 12A and 12B can be manipulated to turn the treatment unit33 about the center axis of the probe 8; that is, the center axis of theultrasonic transducers 50.

Disassembling and assembling can be performed in the same manner asthose in the first embodiment. Cleaning and sterilization can thereforebe achieved after disassembling. The advantages of this embodiment aresubstantially the same as those of the first embodiment.

Referring to FIGS. 13A and 13B, the third embodiment of the presentinvention will be described.

FIGS. 13A and 13B show a major portion of the third embodiment. Thisembodiment has substantially the same structure as the first embodiment.However, an incision plane 62 is formed on a plane that is opposed tothe distal member 7 and interposed between the holding member 1 of themovable section 3 and the distal cover 6.

After a living tissue is clamped by the holding member 1 and distalmember 7, a coagulation plane 61 is used to coagulate the living tissue.The incision plane 62 is formed by narrowing the portion of the movablesection 3 proximal to the coagulation plane 61. A thin living tissueclamped by the incision plane 62 and distal member 7 can therefore beincised by them. The other components are identical to those in thefirst embodiment.

Owing to the foregoing structure, for example, when incision isconducted concurrently with coagulation, a living tissue is clamped andimposed ultrasonic vibrations by inching the holding member 1 and distalmember 7 from an edge of the living tissue. A portion to be incised istherefore coagulated in advance without fail. The possibility ofbleeding can be minimized, and incision can be achieved quite safely.

The other operations and advantages of this embodiment are identical tothose of the first embodiment.

Referring to FIG. 14, the fourth embodiment of the present inventionwill be described.

FIG. 14 shows a major portion of the fourth embodiment. This embodimenthas substantially the same structure as the first embodiment. A meansfor fixing the forceps unit 58 to the sheath 9 is not the snap-fit 38.As shown in FIG. 14 illustrating a section equivalent to the 7E-7Esection in FIG. 4, meshing threads 63 are formed on the distal cover 6and meshing member 37 in order to realize a structure enablingdisassembling and assembling.

The other components are identical to those in the first embodiment. Theoperations and advantages of this embodiment are substantially identicalto those of the first embodiment except the operation for releasing afixed state during disassembling and that for part of assembling.

Referring to FIG. 15, the fifth embodiment of the present invention willbe described.

FIG. 15 shows a major portion of the fifth embodiment. This embodimenthas substantially the same structure as the first embodiment. A meansfor fixing the forceps unit 58 to the sheath 9 is not the snap-fit 38.As shown in FIG. 15, a cam lock 64 formed on the distal cover 6 and thejut 39 (See FIGS. 4 and 7E) of the meshing member 37 are used to realizea structure enabling disassembling and assembling.

The other components are identical to those in the first embodiment. Theoperations and advantages of this embodiment are substantially identicalto those of the first embodiment except the operation for releasing afixed state during disassembling and that for part of assembling.

Referring to FIG. 16, the sixth embodiment of the present invention willbe described.

FIG. 16 shows a major section of the sixth embodiment of the presentinvention. This embodiment has substantially the same structure as thefirst embodiment. However, a means for fixing the forceps unit 58 to thesheath 9 is not the snap-fit 38. As shown in FIG. 16 showing a sectionequivalent to the 7D-7D section of FIG. 4 and its surroundings, anattachment screw 65 is used to realize a structure enablingdisassembling and assembling. Specifically, a screw hole penetrating thesheath and meshing member 37 is formed in the distal cover 6. Theattachment screw 65 is fitted into the screw hole. Thus, the structureenabling disassembling and assembling is realized using the attachmentscrew 65. If necessary, the attachment screw 65 may be tightened with anO ring for attaining watertightness placed intermediately.

The other components are identical to those in the first embodiment. Theoperations and advantages of this embodiment are substantially the sameas those of the first embodiment except the operation for releasing afixed state during disassembling and that for part of assembling.

Referring to FIGS. 17A and 17B, the seventh embodiment of the presentinvention will be described.

This embodiment has substantially the same structure as the firstembodiment. A fixing mechanism using a ball click to stop a turn isimplemented in the bearing 15 or 19 and pipe 14.

An elastic member 79 such as a spring is stowed in a hole penetratingthe pipe 14 between inside and outside. A ball 78 placed on the outerside of the elastic member 79 is constrained to go in anouter-circumferential direction by the elastic force of the elasticmember 79. The inner diameter of the outer end of the hole which isformed in the pipe 14 and in which the ball 78 is stowed is smaller thanthe diameter of the ball 78. There is therefore not the hazard that theconstrained ball 78 may pop up from the hall and come off.

Owing to the ball 78 and numerous click ditches 80 formed on theinner-circumferential surface of the bearing 15 or bearing 19 in adirection parallel to the center axis, the treatment unit 33 can beturned relative to the manipulating means 34 by any angle in units of asmall angle and then locked at a position of any angle that is anintegral multiple of the small angle.

In other words, in a normal use state, a fixed state in which turning isrestricted can be set up by attaining an engaged state in which the ball78 is fitted in any of the click ditches 80. When a turn is made with atorque permitting release of the engaged state, the fixed position canbe varied.

The other components are identical to those of the first embodiment. Theoperations and advantages of this embodiment are substantially the sameas those of the first embodiment except the operation for releasing thefixing mechanism during disassembling and that for part of assembling.

Referring to FIGS. 18 and 19, the eighth embodiment of the presentinvention will be described.

This embodiment has substantially the same structure as the firstembodiment. However, numerous click ditches 80 are formed radially on aring-shaped end surface of the second bearing 19 opposed to the sheath22; that is, as seen from FIG. 18, a proximal end surface of the secondbearing 19, and two click pawls 81 that are formed on an end surface ofthe sheath 22 opposed to the ring-shaped end surface. A fixing mechanismfor stopping a turn is realized by engagement of any of the clickditches 80 and the click pawls 81. The knob 12 is molded using anelastic member. The other components are identical to those of the firstembodiment.

Owing to the foregoing components, for turning the treatment unit 33,the knob 12 is pressed against the proximal end of the manipulatingmeans 23. This causes the knob 12 to abut on the bearing 15 and deformelastically. Eventually, the click pawls 81 come off from the clickditches 80.

The knob 12 is then turned relative to the manipulating means 34,whereby the treatment unit 33 turns relative to the manipulating means34. When the force used to press the knob 12 against the manipulatingmeans 34 is released, the click pawls 81 mesh with the click ditches 80again. Eventually, a stopped state in which a turn is restricted can beset up.

Assuming that the knob 12 is forcibly turned relative to themanipulating means 34 with the click pawls 81 meshed with the clickditches 80, when the click pawls 81 get over the ridges of the clickditches 80, the knob 12 deforms elastically as mentioned above. Thetreatment unit 33 can therefore be turned relative to the manipulatingmeans 34. The other advantages are identical to those of the firstembodiment.

Referring to FIGS. 20 to 25, the ninth embodiment of the presentinvention will be described.

The ultrasound treatment appliance 31 of the first embodiment has thestructure that: two hollow channels are formed in the sheath 9 havingthe capability of a protective member; the forceps unit 58 having thetreatment unit 33 is passed through one of the channels, and the probe 8for conveying ultrasonic waves stemming from the ultrasonic transducers50 is passed through the other channel; the proximal end of the forcepsunit 58 is locked in the movable manipulation means of the manipulatingmeans 34; and thus the holding member can be opened or closed relativeto the distal member 7 of the probe 8 by manipulating the movablemanipulation means. By contrast, this embodiment has such a structureas: a sheath 9 having the capability of a protective member has a singlecylindrical hollow channel; a substantially cylindrical probe 8 ispassed through the sheath 9; a conveying member coupled to a movablemember of a treatment unit 33 is inserted in the probe 8; and theproximal end of the conveying member is extended backward in a hollowdefined by annular ultrasonic transducers 50, and coupled with themovable manipulation means.

An ultrasound treatment appliance 31 has, as shown in FIG. 20, atreatment unit 33, and an insertion unit 57 for inserting the treatmentunit 33 in a living body. A manipulating means 34 for manipulating thetreatment unit 33 is located at the proximal end of the insertion unit57. A handpiece 32 including ultrasonic transducers 50 for supplyingultrasonic vibrations used for a treatment to the treatment unit 33 islocated at the upper proximal end of the manipulating means 34.

The structure including the treatment unit 33 and a probe 8 forconveying ultrasonic vibrations stemming from the ultrasonic transducers50 to the treatment unit 33 is as shown in FIGS. 21 to 23. The treatmentunit 33 is screwed to the distal end of the probe 8, and includes adistal member 7 used to treat a living tissue by means of ultrasonicvibrations.

The distal end of the distal member 7 is molded like a clamp. A distalcover 6 is formed to sandwich a movable section 3 in an area from themiddle of the distal member 7 to the proximal end thereof. The movablesection 3 and the distal end of the distal member 7 mesh with each otherand function as forceps for clamping or freeing a living tissue.

In this embodiment, the distal end that is normally referred to as anablation clamp is thin and shaped to be effective in ablation. As forthe shape, the distal end may be shaped like scissors as that in thesecond embodiment or shaped like the movable section 3 in the thirdembodiment. The shape is not restricted to any particular one.

The movable section 3 is supported in the distal cover 6 by a pin 35 sothat the movable section 3 can pivot freely. The movable section 3 iscoupled with a conveying member 5 by a pin 36. A conveying member 10 isscrewed to the proximal end of the conveying member 5.

The proximal portion of the distal cover 6 and the probe 8 are madehollow. A first operation member 5 and a second operation member 10 arelying through the hollows. The outer circumference of the secondoperation member 10 is covered with a tube 66 made of a material that isresistive to heat and absorbent of ultrasonic vibrations; such as; PTFE.Thus, when ultrasonic vibrations are imposed on the probe 8, occurrenceof a metallic sound due to the contact of the probe 8 with the conveyingmember 10 or a hazard that a contact section is heated or broken isprevented.

Similarly to the first embodiment, an engaging member 42 is coupled withthe proximal end of the conveying member 10 by tightening a screw. Aspherical section 43 is formed at the proximal end of the engagingmember 42. The engaging member 42 is driven to advance or withdraw withthe opening or closing of a movable manipulation handle 30. When theconveying member 5 is driven to advance or withdraw, a force is conveyedto the movable section 3 via the pin 36. The movable section 3 is thendriven to open or close relative to the distal member 7.

In an effort to prevent a hazard that a high-frequency current leaks outto an operator's hand or the like during a treatment using ahigh-frequency current which will be described later, the outercircumference of the engaging member 42 is covered with a tube 67 madeof a material having an electrical insulation ability; such as, PTFE.

The probe 8 is composed of, for example, three parts. The three partsare coupled and assembled by performing TIG welding or the like atpositions Q and R in FIG. 21A.

As shown in FIG. 22A, the pin 35 supporting the movable section 3 sothat the movable section 3 can pivot freely is fixed to the distal cover6 by caulking, laser welding, or the like. The pin 35 is thus unitedwith the distal cover 6. When ultrasonic vibrations are conveyed to thedistal cover 6 as mentioned above, the ultrasonic vibrations are alsoconveyed to the movable section 3 via the pin 35.

The treatment unit 33 and probe 8 having the foregoing structures areinserted in an insertion unit 57 that will be described later, andcoupled with the ultrasonic transducers 50 in the handpiece 32 distal tothe manipulating means 34.

The insertion unit 57 has the structure shown in FIG. 23. A protectivemember 4 made of a material that is resistive to heat and durable toultrasonic vibrations; such as, PTFE or a ceramic is located at thedistal end of the sheath 9 including a plurality of parts in order toprevent a metallic sound or heat dissipation from occurring due to thecontact of the sheath 9 with the distal cover 6 or distal member 7 or toavoid that hazard that the sheath 9 and the distal cover 6 or distalmember 7 are broken.

An O ring 68 and a C ring 69 are attached to the outer circumference ofthe proximal portion of the sheath 9. The proximal portion of the sheath9 is connected to a screw ring 82, which will be described later, in awatertight manner. In this embodiment, the sheath 9 and screw ring 82are connected to each other by means of the C ring 69. Alternatively,for example, the structure composed of the snap-fit 38 and jut 29 in thefirst embodiment, the connection mechanism using the attachment threads63 in the fourth embodiment, the structure using the cam-lock 64 in thefifth embodiment, or the structure using the attachment screw 65 in theeighth embodiment will do. The connection means is not limited to anyparticular one.

Next, the manipulating means 34 will be described. As shown in FIG. 24,a first bearing 15 is attached at the upper distal end of a supportingmember 72 of the manipulating means 34 by means of screws 71. A secondbearing 19 is attached at the upper middle of the supporting member 72thereof by means of screws 73.

The screw ring 82 is inserted in the distal end of the first bearing 15and screwed to the handpiece 32 with the bearing 15 between them. Thescrew ring 82 can be turned freely together with the handpiece 32 withinthe first bearing 15. An O ring 45 ensures watertightness.

The aforesaid sheath 9 is attached to the distal end of the screw ring82 by the C ring 69. A watertight state is retained relative to thefirst bearing 15 by means of a watertightness means such as an O ring68. In this embodiment, a perfusion/aspiration base 51 is formed on thetop of the first bearing 15. When a perfusion/aspiration means that isnot shown is connected to the perfusion/aspiration base 51, perfusion oraspiration can be performed using the channel lying through the sheath 9from the first bearing 15.

The proximal end of the handpiece 32 is inserted in the second bearing19 and is supported by an O ring 47. The handpiece 32 can be turned ifnecessary owing to the O ring 45 and O ring 47. The handpiece 32 isfreely turnable relative to the manipulating means 34 with a properturning resistance disabling unexpected turning.

The fixing mechanism for stopping a turn may be realized with, forexample, a ball-click mechanism employed in the seventh embodiment or aclick mechanism employed in the eighth embodiment.

The ultrasonic transducers 50 for supplying ultrasonic vibrations usedto treat a living tissue are, as mentioned above, installed in the formof rings in the handpiece 32. The proximal end of the probe 8 is coupledwith the distal end of a drive axis or an axis of ultrasonic vibrationsgenerated by the ultrasonic transducers 50 by tightening a screw.

The second operation member 10 is inserted in the probe 8, and juttingout behind the proximal end of the handpiece 32 through the channeldefined by the ultrasonic transducers 50.

For the purpose of preventing leakage of gas attributable topneumoperitoneum or the like through the channel which is extending tothe proximal end of the handpiece 32 and in which the conveying member10 is inserted, an airtightness member 74 that is shaped substantiallylike a tube is located near the proximal end of the channel and secondoperation member 10. The airtightness member 74 is molded using, forexample, an elastic member made of rubber or the like or a seal membermade of PTFE or the like.

The engaging member 42 is coupled with the proximal end of the secondoperation member 10 by tightening a screw. The outer circumference ofthe engaging member 42 is covered with a tube 67 made of an electricallyinsulating material such as PTFE in order to prevent a high-frequencycurrent from leaking out during a treatment using a high-frequencycurrent which will be described later.

The spherical section 43 is formed at the proximal end of the engagingmember 42. As shown in FIG. 25A, the spherical-section 43 meshes with anengagement receiving member 75 embedded in the upper part of the movablemanipulation handle 30. The engagement receiving member 75 has, as shownin FIGS. 25A and 25B, a vertical ditch. The spherical section 43 canslide within the ditch.

The upper opening of the ditch in the engagement receiving member 75 hasa width permitting the spherical section 53 to pass through it. Thelower opening thereof has a width not permitting the spherical-sectionto pass through it. The root of the spherical section 53 is enclosed inthe lower opening. Normally, the spherical section 53 is fitted in thelower part of the ditch.

Owing to the foregoing structure, when the movable manipulation handle30 is opened or closed relative to a stationary manipulation handle 29,the engaging member 42 can be driven to advance or withdraw. With theadvancement or withdrawal of the engaging member 42, the conveyingmember 10 and conveying member 5 screwed to the engaging member 42 aredriven to advance or withdraw. This causes the movable section 3 to openor close relative to the distal member 7.

The stationary manipulation handle 29 is joined with the proximal end ofthe supporting member 72 by means of a screw 76 and a nut 77. Themovable manipulation handle 30 is, as shown in FIG. 25B, supported bythe stationary manipulation handle 29 so that the movable manipulationhandle 30 can pivot freely. As mentioned above, the movable manipulationhandle 30 can therefore be opened or closed relative to the stationarymanipulation handle 29.

Next, an actual example of use of this embodiment will be described.

First, the treatment unit 33 is opposed to a living tissue to betreated. Next, the handpiece 32 is turned relative to the manipulatingmeans 34 so that the orientation of the treatment unit 33 will bematched with a direction convenient for treating the living tissue.

The movable manipulation handle 30 is then moved in an open direction sothat the movable section 3 will open. The living tissue to be treated isclamped with an appropriate force. Thereafter, the ultrasonictransducers 50 are driven using a driving power supply, which is notshown, dedicated to the ultrasonic transducers 50. Ultrasonic vibrationsare then conveyed to the distal member 7 and movable section 3 andeventually imposed on the living tissue.

At this time, as mentioned above, when a treatment is conducted with thefactors set as; a large amplitude of ultrasonic vibrations, a largeclamping force, and a long time of imposition of ultrasonic vibrations,it is convenient for incising a living tissue. The reverse setting ofthe factors is convenient for coagulation. A proper treatment should beconducted in consideration of the situation of a living tissue.

Moreover, when a high-frequency current is applied from a power supplythat is not shown into the ultrasonic transducers 50, the high-frequencycurrent can be applied from the ultrasonic transducers 50 to a livingtissue via the probe 8, distal cover 6, distal member 7, and movablesection 3. A treatment using a high-frequency current can be conducted.

The outer circumference of the engaging member 42 that is exposed iscovered with the tube 67 having an electrical insulation ability.Besides, when the movable manipulation handle 30, sheath 9, screw ring82, bearing 15, handpiece 32, casing, and the like are molded using amaterial having the electrical insulation ability; such as, PEEK orpolysulfone, leakage of a high-frequency current can be prevented. Atreatment can therefore be conducted safely.

A treatment by ultrasonic vibrations and a treatment by a high-frequencycurrent can be conducted independently. These treatments may beconducted separately or simultaneously.

Next, the procedure of disassembling or assembling the components ofthis embodiment will be described.

First, the sheath 9 is pulled out distally from the screw ring 82. Next,the stationary manipulation handle 29 is dismounted downward from thesupporting member 72 by removing the screw 76. Accordingly, the movablemanipulation handle 30 moves downward. The spherical section 43 fittedin the engagement receiving member 75 comes off from the ditch. Thiscauses the engaging member 42 to fall off the movable manipulationhandle 30.

Thus, a united body of the stationary manipulation handle 29 and movablemanipulation handle 30 is disassembled from the manipulating means 34.

Next, the screw ring 82 is dismounted from the handpiece 32.Accordingly, the screw ring 82 is disassembled from the bearing 15.Thereafter, the handpiece 32 is pulled out proximally from the bearing15 and bearing 19. A united body of the handpiece 32, probe 8, and thelike is disassembled from the manipulating means 34.

The probe 8 is dismounted from the handpiece 32, and the engaging member42 is dismounted from the conveying member 10. Thereafter, the distalmember 7 is dismounted from the probe 8.

Due to the foregoing disassembling, the ultrasound treatment appliance31 is brought into a state in which cleaning and sterilization can beachieved successfully. The respective parts can be cleaned andsterilized.

For assembling the components of the ultrasound treatment appliance 31again, the components are assembled by reversing the aforesaiddisassembling procedure.

Moreover, since disassembling and assembling can be achieved asmentioned above, if any part should be broken, the part alone would haveto be replaced with a new one. The ultrasound treatment appliance can bereused.

Referring to FIG. 26, the tenth embodiment of the present invention willbe described.

FIG. 26 shows the tenth embodiment of the present invention. Thisembodiment has substantially the same structure as the ninth embodiment.However, the probe 8 is curved, and the sheath 9 and conveying member 10lying through the sheath 9 are formed with an elastic member. Theconveying member 10 is formed, for example, with a super-elastic wire orthe like made of an alloy of nickel and titanium. The sheath 9 is moldedusing a member with plasticity, for example, a member made of PTFE.

The curved probe 8 can therefore be inserted in the sheath 9. Beside,the conveying member 10 can advance or withdraw within the probe 8 whendriven.

Owing to the foregoing structure, the treatment unit 33 can be turnedrelative to the manipulating means 34. At the same time, bettermaneuverability is ensured.

The other components and operations are identical to those of the ninthembodiment.

Referring to FIGS. 27 to 39, the eleventh embodiment of the presentinvention will be described.

As shown in FIG. 27, an ultrasound treatment appliance 100 comprises: anoperation unit 103 including a handpiece 102 in which ultrasonictransducers for generating ultrasonic vibrations is incorporated andhaving a stationary manipulation handle 131 and a movable manipulationhandle 132 serving as an action instructing member; a treatment unit 104including a distal member 141 that is a stationary section of thetreatment unit to which ultrasonic vibrations generated in the handpiece102 incorporated in the operation unit 103 and used to treat a livingtissue are conveyed, and a holding member 142 that is opposed to thedistal member 141 and that is a movable section of the treatment unitwhich clamps or frees a living tissue in cooperation with the distalmember 141; and a sheath 111 that is a protective member for covering avibration conveying member, which will be described later, for conveyingvibrations of the handpiece 102 to the distal member 141 of thetreatment unit 104 and an operation member, which will be describedlater, for conveying an action of clamping or freeing made by themovable manipulation handle 132 to the holding member 142.

The stationary manipulation handle 131 of the operation unit 103 isunited with a transducer cover 133 that includes the handpiece 102, thatis tubular, and that has windows 133 a formed on the lateral sidethereof. On the other hand, the movable manipulation handle 132 isscrewed to the transducer cover 133 so that the movable manipulationhandle 132 can pivot freely with respect to a handle supporting-pointpin 134. On the movable manipulation handle 132, locks 135 each having alock pawl 135 a that locks a rotor, which will be described later and isinserted in the transducer cover, in the transducer cover so that therotor will be freely detachable are formed and oriented to a center axisseen through the windows 133 a of the transducer cover 133.

A turnable knob 112 is fixed unitedly to the end of the sheath 111 onthe side of the operation unit. The turnable knob 112 is used to turnthe holding member 142 constituting the treatment unit 104 with respectto the center axis of the distal member 141. Reference numeral 113denotes an electrode plug to which a fulguration power supply isconnected.

As shown in FIG. 28, the sheath 111 is constructed so that it will befreely detachable from the transducer cover 133 constituting theoperation unit 103. By dismounting the sheath 111 from the transducercover 133, a probe 143 that is a vibration conveying member forconveying vibrations of the handpiece 102 to the distal member 141 andan operation rod 144 that is an operation member for conveying aninstruction of an action of clamping or freeing from the movablemanipulation handle 132 to the holding member 142 emerge. The sheath 111has a through bore 111 a having a substantially elliptic section. In thethrough bore 111 a, a distal coupler 145 that is a holding member forpreventing the probe 143 and operation rod 144 from touching the sheath111 as well as a plurality of couplers 146 are arranged.

The probe 143 and operation rod 144 are inserted in through bores, whichwill be described later, formed in the distal coupler 145 and pluralityof couplers 146. The distal coupler 145 and plurality of couplers 146have substantially the same shape as the section of the through bore 111a formed in the sheath 111. The distal coupler 145 and plurality ofcouplers 146 are arranged unitedly in the through bore 111 a because thestraight sides of the elliptic section serve as detents. The distalcoupler 145 and plurality of couplers 146 turn unitedly in the samedirection responsively to the turn of the sheath 111.

The holding member 142 is fixed to the distal coupler 145 so that theholding member 142 can pivot with respect to a pin 147. The distalportion of the operation rod 144 is coupled with the holding member 142.The back end of the operation rod 144 is inserted in an inner hole 133 bof the transducer cover 133 and connected to the rotor, which will bedescribed later, locked by the movable manipulation handle 132. When themovable manipulation handle 132 is manipulated toward the stationarymanipulation handle, the operation rod 144 withdraws to cause theholding member 142 to move toward the distal member.

The distal member 141 jutting out from the distal coupler 145 is screwedto and detachable from the distal end of the probe 143. The back end ofthe probe 143 is screwed to and detachable from a horn 121 located atthe distal end of the handpiece 102.

As shown in FIG. 29, the probe 143 coupled with the distal member 141and the operation rod 144 coupled with the holding member 142 aredetachable from the operation unit 103.

Since the back end of the probe 143 is screwed to the distal end of thehorn 121 located at the distal end of the handpiece 102, the probe 143can be readily dismounted from the operation unit 103 by unscrewing itfrom the horn. When the probe 143 is connected to the horn 121 placed inthe operation unit 103, the connection can be achieved readily byscrewing.

On the other hand, the back end of the operation rod 144 is connected toa rotor 148 serving as a connecting means. The rotor 148 is freelydetachable from the operation unit 103. The rotor 148 is a tubularmember having a through hole 148 a in which the horn 121 is inserted. Aconvex part 148 b that slides in the inner hole 133 b of the transducercover 133 is formed in the center of the rotor 148. A ditch 148 cserving as a connecting means in which the lock pawls 135 b of the locks135 formed on the movable manipulation handle 132 are fitted is formedin the convex part 148 b.

The rotor 148 inserted in the inner hole 133 b of the transducer cover133 can therefore be readily dismounted by, as shown in FIG. 30,removing the lock pawls 135 a formed on the locks 135 of the movablemanipulation handle 132 and fitted in the ditch 138 c of the rotor 148inserted in the inner hole 133 b of the transducer cover 133.

For connecting the rotor 148 to the transducer cover 133 constitutingthe operation unit 103, first, the rotor 148 to which the back end ofthe operation rod 144 is connected is inserted in the through hole 133 bof the transducer cover 133 with the convex part 148 b of the rotor 148facing the wall of the through hole 133 b. Next, as shown in FIG. 30,the ditch 148 c dug in the convex part 148 b is opposed to the windows133 a of the transducer cover 133. The locks 135 that can freely benodded and are attached to the movable manipulation handle 132 are thennodded, whereby the lock pawls 135 a of the locks 135 are fitted in theditch 148 c. Consequently, the rotor 148 is locked in the inner hole 133b of the transducer cover 133 constituting the operation unit 103 sothat the rotor 148 can freely slide in the longitudinal direction andcircumferential direction of the inner hole 133 b.

A convex part 148 d is formed as a detent on the distal portion of therotor 148. In an assembled state, the convex part 148 d is fitted in anengagement ditch formed in the inner circumference, which is not shown,of an engagement part 112 a serving as the proximal portion of theturnable knob 112. When the convex part 148 d of the rotor 148 isunitedly engaged with the turnable knob 112, the rotor 148 is turnedresponsively to the turn of the turnable knob 112.

As for a connecting method for locking the rotor 148 in the inner hole133 b of the transducer cover 133 so that the rotor 148 can freely slidein the longitudinal direction and circumferential direction of the innerhole 133 b, as shown in FIG. 31, the ditch 148 c of the rotor 148 may beopposed to the window 133 a formed in the top of the transducer cover133, and a lock bar 136 that is freely movable vertically may be moveddownward and fitted in the ditch 148 c. Alternatively, as shown in FIGS.32A and 32B, the movable manipulation handle 132 may be provided withthe lock pawls 135 a, lock holes 137 a, and detachment holes 137 b. Atransition is made from a state in which the handle supporting-point pin134 is inserted in the detachment holes 137 b of the movablemanipulation handle 132 to a state in which the handle supporting-pointpin 134 is inserted in the lock holes 137 a of the movable manipulationhandle 132, whereby the lock pawls 135 a are fitted in the ditch 148 c.Thus, various forms are conceivable.

As shown in FIG. 33, the distal member 141 jutting out from the distalcoupler 145 is a cylindrical member made of titanium or aluminum thatexerts a high sound effect and that is well-adaptable to a living body,or an alloy of titanium and aluminum. A thread-like irregular section141 a is formed by finishing the surface of the distal member 141 inorder to increase the contact area for a living tissue to be clamped incooperation with the holding member 142. By making the pitch of theirregular section 141 a finer for the amplitude of ultrasonicvibrations, a coefficient of friction occurring between the holdingmember 142 and a living tissue due to the vibrations of the holdingmember 142 can be increased. Moreover, coagulation efficiency can befurther improved. The distal end of the irregular section 141 a and thedistal end of the holding member 141 are chamfered for fear the distalends may injure a living tissue.

The finishing performed to increase the contact area of the surface ofthe distal member 141 for a living tissue is not confined to thethread-like irregular section 141 a. Alternatively, the finishing may beperformed to create a satin surface 141 b shown in FIG. 34A or to createa plurality of thin ditches 141 c circumferentially as shown in FIG.34B. Even when the thin ditches 141 c are created on the distal member141, the distal end of the distal member is chamfered. A living tissuewill therefore not be injured

Moreover, a tapered side 141 d shown in FIG. 35 may be created on thedistal member 141 that used to be cylindrical in order to upgrade theeffect of ultrasonic vibrations. At this time, the finishing to beperformed on the distal member 141 is confined to the side of the distalmember 141 facing the holding member 142.

As shown in FIGS. 36A to 37, the probe 143 and operation rod 144 areconstructed to be detachable from the distal coupler 145 and pluralityof couplers 146. The distal coupler 145 has a ditch 145 a, in which theholding member 142 and operation rod 144 are placed, a through hole 145b in which the distal member 141 and probe 143 are placed, and adetachment slit 145 c. The couplers 146 have a thin hole 146 a in whichthe operation rod 144 is inserted, a detachment slit 146 b, a throughhole 146 c in which the probe 143 is inserted, and a detachment slit 146d. The distal coupler 145 and couplers 146 from which the probe 143 andoperation rod 144 are freely detachable are made of a fluorocarbon resinmaterial that improves sliding efficiency; such as Teflon.

As shown in FIG. 36A, the distal coupler 145 and couplers 146 are placedin ditches 143 a and 143 b formed at given positions on the probe 143.As shown in FIG. 36B, the ditches 143 a and 143 b on the probe 143 areformed at nodes of an oscillatory wave in order to avoid the influenceof vibrations stemming from the ultrasonic transducers. On the otherhand, junctions at which the probe 143 is screwed to the distal member141 and horn 121 are located at antinodes of the oscillatory wave onwhich the stress attributable to vibrations does not concentrate.

As shown in FIGS. 38A and 38B, male screws 143 c and 143 d are formed atboth ends of the probe 143. The male screws 143 c and 143 d are engagedwith female screws (not shown) formed in the distal member 141 and horn121 respectively. Thus, vibrations stemming from the ultrasonictransducers are conveyed to the distal member 141 by way of the horn 121and probe 143.

The members for conveying vibrations generated by the ultrasonictransducers are made of titanium or aluminum that exerts a high soundeffect and that is well-adaptable to a living body, or an alloy oftitanium and aluminium. Titanium hardly distorts due to a break, isresistive to a break, and well-adaptable to a living body. For thesereasons, titanium is regarded optimal. However, titanium is hard tomachine and is expensive. By contrast, aluminium is relatively easy tomachine and inexpensive. However, there is a problem concerningstrength; that is, aluminum is susceptible to heat generated due tovibrations.

When the ultrasound treatment appliance is used as a disposableappliance, the horn 121, probe 143, and distal member 141 may be formedwith aluminum members. When priority is given to a treatment such asincision or coagulation, at least the distal member 141 shouldpreferably be made of titanium. When the ultrasound treatment appliance100 is constructed so that the components can be disassembled andassembled, it is preferred that titanium offering great strength anddurability is used. In this case, the ultrasound treatment appliance 100becomes expensive.

In this embodiment, the distal member 141 constituting the treatmentunit and the horn 121 for supplying ultrasonic vibrations stemming fromthe ultrasonic transducers to the probe 143 are made of titaniumoffering high durability. The probe 143 serving as a relay memberlinking the horn 121 and distal member 141 is made of inexpensivealuminum.

As shown in FIG. 38C, female screws 143 e and 143 f may be formed inboth end portions of the probe 143. In this case, a male screw 141 aassociated with the female screw 143 e of the probe 143 is formed on thedistal member 141, and a male screw 121 a associated with the femalescrew 143 f of the probe 143 is formed on the horn 121.

Moreover, as shown in FIG. 39A, the handpiece 102 is placed in thethrough hole 133 b of the transducer cover 133. At this time, thehandpiece 102 must be placed stably at a given position in the throughhole 133 b. A positioning section 133 c is therefore formed in thethrough hole. A positioning notch 122 a is formed on a flange 122 of thehandpiece 102. When inserted in the through hole 133 b of the transducercover 133, the handpiece 102 is fixed stably at the given position by afixture 124 via a packing 128 such as an O ring.

Moreover, as shown in FIG. 39B, a manipulation handle 133 c into which astationary manipulation handle and a movable manipulation handle areintegrated may be attached to the transducer cover 133.

A treatment to be conducted by inserting the ultrasound treatmentappliance 100 having the foregoing structure into the abdominal cavitywill be described.

First, the movable manipulation handle 132 constituting the operationunit 103 of the ultrasound treatment appliance 100 is manipulated towardthe stationary manipulation handle in order to clamp a living tissue tobe treated by the distal member 141 and holding member 142. The rotor148 locked in the through hole of the transducer cover 133 by the lockpawls 135 a formed on the movable manipulation handle 132 then withdrawsin the through hole. This causes the operation rod 144 connected to therotor 148 to withdraw in the same manner. The holding member 142 thenmoves toward the distal member. Thus, the living, tissue is clamped bythe distal member 141 and holding member 142.

Next, in the above state, the ultrasonic transducers, which are notshown, incorporated in the handpiece 102 are driven using a ultrasonictransducer driving power supply in order to generate ultrasonic waves.Ultrasonic vibrations generated in the handpiece 102 are conveyed to thedistal member 141 by way of the horn 121 and probe 143. When theultrasonic vibrations are conveyed to the distal member 141, the distalmember 141 vibrates. The vibrations are conveyed to the clamped livingtissue through the thread-like irregular section 141 a formed byfinishing the surface of the distal member 141. Frictional heat thendevelops to coagulate the living tissue. While ultrasonic vibrations arebeing imposed on a living tissue, if a clamping force used to clamp theliving tissue is increased by manipulating the movable manipulationhandle 132 further toward the stationary manipulation handle, theholding member 142 approaches the distal member 141. Consequently,incision is completed without bleeding from the living tissue.

Thereafter, the treatment unit 104 is moved to a region in which anotherliving tissue to be treated is present. At this time, the positionalrelationship between the operation unit 103 and treatment unit 104 ischanged from the one set during the previous treatment. The turnableknob 112 is therefore turned in order to improve workability. The sheath111 to which the turnable knob 112 is secured is turned together withthe rotor 148 locked in the through hole of the transducer cover 133.

When the sheath 111 turns, the distal coupler 145 and couplers 146placed in the through hole 111 a of the sheath 111 are turned withrespect to the center axes of the distal member 141 and probe 143. Whenthe holding member 142 reaches a desired position, the turnable knob 112is stopped turning. In order to clamp a living tissue to be treated bythe distal member 141 and holding member 142, the movable manipulationhandle 132 constituting the operation unit 103 of the ultrasoundtreatment appliance 100 is manipulated toward the stationarymanipulation handle. Thus, the living tissue is clamped and treated.

As mentioned above, the distal member constituting the treatment unit isshaped like a round bar. The surface of the round bar is finished inorder to increase the contact area for a living tissue. Consequently,frictional heat develops efficiently in the living tissue owing toultrasonic vibrations conveyed from the ultrasonic transducers to thedistal member. A treatment such as coagulation or incision can thereforebe conducted smoothly.

A detent is formed on each of the outlines of the distal coupler andplurality of couplers in which the probe and operation rod are placed.The distal coupler and couplers are therefore unitedly placed in theinner hole of the sheath. Besides, the rotor is united with the turnableknob. The distal coupler, plurality of couplers, and rotor are thereforeturned in the same direction responsively to the turn of the sheath madeby manipulating the turnable knob. The holding member can therefore beturned to a desired position with respect to the center axis of thedistal member. Consequently, the positional relationship between theoperation unit and treatment unit can be modified without the necessityof turning the operation unit in which the ultrasonic transducers areincorporated. Eventually, not only the operator workability improvesgreatly but also a cord extending from the operation unit will nottangle.

Next, the procedure of disassembling or assembling the components ofthis embodiment will be described.

First, the sheath 111 is dismounted, as shown in FIG. 28, from theultrasound treatment appliance 100 shown in FIG. 27 in an assembledstate. The sheath 111 thus becomes a separate body. The probe 143,operation rod 144, and treatment unit 104 mounted in the distal coupler145 and plurality of couplers 146 placed in the inner hole 111 a of thesheath 111 emerge.

Next, the probe 143 and horn 121 are unscrewed and freed from eachother. The rotor 148 locked in the operation unit 103 is dismounted. Atthis time, the locks 135 formed on the movable manipulation handle 132fixed to the transducer cover 133 of the operation unit 103 at asupporting point are swayed backward. This causes the lock pawls 135 ato become free from the ditch 148 c of the rotor 148 inserted in thetransducer cover. The rotor 148 is then, as shown in FIG. 28, pulledout. The operation unit 103 is now a separate body.

Thereafter, as shown in FIGS. 36A and 37, the probe 143 and operationrod 144 are dismounted from the distal coupler 145 and plurality ofcouplers 146.

Thereafter, the probe 143 and distal member 141 are unscrewed from eachother. The distal member 141 is then detached from the probe 143. Whenthe pin 147 is pulled out of the distal coupler 145, the holding member142 is dismounted from the distal coupler 145.

The series of operations brings the ultrasound treatment appliance 100into a state in which the respective components can be fully cleaned andsterilized. If necessary, the movable manipulation handle 132constituting the operation unit 103 may be dismounted and then thehandpiece 102 may be dismounted.

After the disassembled components are cleaned and sterilized, when thecomponents are assembled again, the foregoing procedure of disassemblingis reversed. Thus, the ultrasound treatment appliance 100 can bereconstructed.

As mentioned above, the structure enables disassembling and assembling.The disassembled components can be fully or reliably cleaned andsterilized without labor. If any member should be broken, the brokenmember alone would have to be replaced with a new one. Thus, theultrasound treatment appliance can be used continually and economically.

Moreover, the distal member constituting the treatment unit, and thehorn for supplying ultrasonic vibrations stemming from the ultrasonictransducers to the probe are made of highly-durable titanium. The probeserving as a relay member linking the horn and distal member is made ofinexpensive aluminum. Thus, the ultrasound treatment appliance capableof conveying ultrasonic vibrations stemming from the ultrasonictransducers to the distal member without deteriorating the performanceof a treatment such as incision or coagulation can be providedinexpensively.

Furthermore, when the distal member to be screwed to the distal end ofthe probe is replaced with another one having a shape, size, andfinished surface optimal to a treatment, the treatment can be conductedefficiently.

Furthermore, the rotor to be locked in the operation unit may beprovided with a convex part and each of the locks may be provided with aconcave part. Even in this case, the same operations and advantages asthose mentioned above are available.

Referring to FIGS. 40 to 43, the twelfth embodiment of the presentinvention will be described.

In FIG. 40, unlike the aforesaid embodiment, a clamp unit 104 composedof a holding member 142 a and a distal member 141 is manipulated forclamping or freeing by advancing or withdrawing a sheath 115 withoutusing an operation rod 144. In this case, an ultrasound treatmentappliance 101A is constructed by forming the clamp unit 104 as shown inFIG. 41. The same operations and advantages as those provided by theaforesaid embodiment can be provided.

Specifically, as shown in FIG. 41, for structuring the clamp unit 104 asshown in FIG. 41, first, the holding member 142 a is attached to adistal coupler 145 so that the holding member 142 a can pivot withrespect to a pin 147. At this time, a torsion coil spring 149 forconstraining the holding member 142 a to go in an open direction ismounted. Next, a through hole 145 b formed in the distal coupler 145 towhich the holding member 142 a and torsion coil spring 149 are attachedis matched with a ditch 143 a of a probe 143. Thus, the clamp unit 104is structured.

The clamp unit 104 is inserted in a through hole 115 a of the sheath115. At this time, the distal coupler 145 formed at the distal end ofthe sheath 115 is fitted in an engagement ditch 115 b that serves as adetect and that is used to unite the distal coupler 145 with the sheath115. The ultrasound treatment appliance 101A is thus constructed. Theultrasound treatment appliance 101A can therefore achieve clamping andfreeing using the distal member 141 and holding member 142 by advancingor withdrawing the sheath 115.

Furthermore, when the sheath 115 is turned as shown in FIG. 42, thedistal coupler 145 turns in the same direction responsively to the turnof the sheath 115. Thus, the holding member 142 a can be set to adesired position with respect to the center axis of the distal member141.

When the sheath 115 is, as shown in FIG. 43, covered with a protectivetube 116 or the like, a detent 117 composed of a concave part and aconvex part as illustrated may be formed so that the protective tube 116and sheath 115 can turn unitedly. Thus, the sheath 115 and distalcoupler 145 turn in the same direction responsively to the turn of theprotective tube 116. Eventually, the holding member 142 a can be set toa desired position with respect to the center axis of the distal member141.

Referring to FIGS. 44 to 46, the thirteenth embodiment of the presentinvention will be described.

An ultrasound treatment appliance 100B of this embodiment has astructure basically resembling the structure of that of the eleventhembodiment. As shown in FIG. 44, in the ultrasound treatment appliance101B, the transducer cover 133 of the ultrasound treatment appliance 100of the eleventh embodiment is divided into two parts; an adaptor 155serving as a frontal part and a transducer cover 157 serving as a rearpart for covering internal transducers.

A turnable knob 112 located in the vicinity of the back end of a sheath111 is screwed to the front end of the adaptor 155 so that the turnableknob 112 will be freely detachable. The front end of the transducercover 157 is screwed to the back end of the adaptor 155 so that thetransducer cover 157 will be freely detachable.

A stationary operation unit 131 is united with the adaptor 155. Locks135 located near the top edges of a movable manipulation handle 132,which is attached so that the movable manipulation handle 132 can pivotwith respect to a handle supporting-point pin 134, have lock pawls 135a. The lock pawls 135 a are fitted in the ditch of a rotor placed insidethrough windows 133 a formed at opposite positions on the lateral sideof the adaptor 155. The adaptor 155 and stationary and movablemanipulation handles 131 and 132 constitute an operation unit 156.

Similarly to the eleventh embodiment, the rotor is mounted outside ahorn whose back end is connected to transducers so that the rotor canmove back and forth freely. By manipulating the movable manipulationhandle 133, the rotor is moved back and forth. Thus, a holding member142 is opened or closed via an operation rod whose back end is fixed tothe distal end of the rotor. The horn lies through the adaptor 155 andis connected to the transducers within the transducer cover 133connected to the back end of the horn. The back end of a probe 143 isconnected to the distal end of the horn using a screw so that the probe143 will be freely detachable.

Moreover, as shown in FIG. 45, the front and back of a flange 152located at a position nearest to the distal end of the probe 143 andcoincident with an antinode of vibrations are sandwiched and fixed by adistal coupler 153, with which the holding member 142 is coupled so thatthe holding member 142 can pivot, and a tightening ring 154. At the timeof sandwiching the flange 152, an elastic member such as a packing forpreventing the vibrations of the flange 152 from traveling to the distalcoupler 153 and tightening ring 154 may be placed intermediately.

As shown in FIGS. 46A and 46B, the holding member 142 constituting atreatment unit 104 is supported by a pin 147 at an upper position of adistal member 141 in the vicinity of the distal end of the distalcoupler 153 so that the holding member 142 can pivot freely. The distalend of an operation rod 144 is coupled with the distal coupler 153 at aposition near the distal end of the distal coupler 153.

As mentioned above, an effort is made so that the prove 143 will notmake a relative turn in relation to the sheath 111. The transducers withwhich the probe 143 is coupled via the horn are unitedly connected tothe transducer cover 157 and thus structured so that the transducerswill not turn relative to the transducer cover. In short, the probe 143itself has the same structure as that in the first embodiment, thoughtit has a different outline.

The operation unit 156 including the adaptor 155 is connected directlyto a unit composed of the probe, sheath 111, and transducer cover viathe lock pawls 135 a, and coupled with the transducer cover 157 andturnable knob 112 by way of coupling means located at both ends of theadaptor 155.

This embodiment exerts such an operation that: when the turnable knob112 is turned, the transducer cover 157, sheath 111, holding member 142,and distal member 141 are turned relative to the operation unit 156.This embodiment has substantially the same advantages as the otherembodiments.

In the aforesaid embodiments, it is apparent that in a structure inwhich disassembling and assembling are enabled by engaging or attaching,for example, a screw with or to a screw hole or a male screw with or toa female screw, a member having the screw or male screw may be exchangedfor a member having the screw hole or female screw. The same applies tothe engagement or fitting of a jut, pawl, pin, or the like with or in aconcave part, ditch, or the like.

Embodiments formed by combining some of the constituent features of theaforesaid embodiments also belong to the present invention.

As mentioned above, as long as the gist of the present invention thatthe sheath of an insertion unit for inserting a treatment unit of anultrasound treatment appliance, which is used to treat a living tissue,is made turnable relative to a manipulating means is conformed with, anyother structure may have any purport. No restriction is placed on thecontents of a purport.

Referring to FIGS. 47 to 49, the fourteenth embodiment of the presentinvention will be described.

As shown in FIG. 47, an ultrasound treatment system 201 of the presentinvention comprises: an ultrasound treatment appliance 202 includingtransducers used for coagulation or incision by ultrasonic waves; adrive unit 90 for supplying a driving signal to the transducers in theultrasound treatment appliance 202 over a driving signal conveying cord204; a foot switch 205 connected to the drive unit 90 and used to turnon or off a driving signal; a cautery knife unit 91 that is connected toa treatment electrode receptor (active cord pin receptor) 206 attachedto the ultrasound treatment appliance 202 over an active cord 207 havinga detachable connector 207 a and that generates a cautery knife signalsupplied to a living body through the distal end of the ultrasoundtreatment appliance 202 for the purpose of resection or the like; ancounter electrode board 209 a connected to the cautery knife unit 91 andplaced in contact with a wide area of a living body over a cautery knifesignal return cord 209; and a foot switch 210 connected to the cautery,knife unit 91 and used to turn on or off a cautery knife signal.

Referring to FIG. 48, the electrical internal configuration of theultrasound treatment system 201 will be described. As illustrated,disk-like ultrasonic transducers 211 are incorporated in laminated formwithin a transducer cover 212 of the ultrasound treatment appliance 202.The laminated ultrasonic transducers 211 are joined with a probe 215 viaa horn 213. Two electrodes; voltage input electrodes 232 a and 232 b areformed on respective sides of each ultrasonic transducer 211. In thisembodiment, one of the two electrodes or the voltage input electrode 232b is electrically connected to the metallic (broadly conducting) probe215 over a line 233.

The treatment electrode receptor 206 serving as a cautery knife inputdevice is electrically linked to the line 233 connected to the onevoltage input electrodes 232 b. Part of a cautery knife signal sent froma cautery knife signal generating circuit 235 in the cautery knife unit91 is therefore fed to a drive circuit 94 for driving the ultrasonictransducers 211 over the line 233. This fact is utilized for sensing. Amore specific configuration of the drive unit 90 is shown in FIG. 49.

As shown in FIG. 49, the drive circuit 94 generates a high-frequencysine-wave signal with a given frequency which is used to drive and makeresonant the ultrasonic transducers 211. The high-frequency signaloutput is recomposed into a driving signal by an output transformer 236,and applied to the ultrasonic transducers 211 in the ultrasoundtreatment appliance 202 through contacts 237 a of a relay 237. Thisresults in ultrasonic vibrations. The secondary coil L of the outputtransformer 236 is a resonant coil connected in parallel with theultrasonic transducers 211, and becomes resonant with an oscillatoryfrequency of the drive circuit 94 so as to excite the ultrasonictransducers 211. When a cautery knife signal is applied to the treatmentelectrode receptor 206 serving as a cautery knife signal input devicefor the ultrasound treatment appliance 202, a sense circuit 92 of a peakdetection type converts the signal into a corresponding direct currentas described below. Thus, the cautery knife signal is detected.

The sense circuit 92 adopts a peak detection method in which capacitorsC1 and C2 stores fractions of an input voltage, a detector D detects anAC cautery knife signal developing at the capacitor C2, correspondingcharge is accumulated in a capacitor C3, and the peak value of thecharge is detected.

An output of the sense circuit 92 is input to a control circuit 93 via abuffer 240. In this control circuit 93, for example, an incorporatedcomparator compares the level of an input signal with a reference value.When the level of an input signal exceeds the reference value, a CPUthat is not shown judges on the basis of an output of the comparatorthat a cautery knife signal has been applied to the probe 216 or acautery knife signal is present. When the level of the input signal doesnot exceed the reference value, it is judged that no cautery knifesignal has been applied.

When judging on the basis of a comparator output that a cautery knifesignal has been applied, the CPU allows an alarm sound generatingcircuit that is not shown to give the alarm through a speaker 95, thusindicates that a cautery knife signal has been applied, and then promptsan operator to stop driving of ultrasonic waves. At the same time, theCPU allows a display drive circuit that is not shown to indicate on adisplay 96 that an cautery knife signal has been applied and thatdriving of ultrasonic waves should be stopped.

Furthermore, when judging that a cautery knife signal has been applied,the CPU switches off the contacts 237 a so as not to cause a current toflow through a solenoid 237 b of the relay 237. Besides, the CPUcontrols the drive circuit 94 so as to stop generation of a signal usedto drive the ultrasonic transducers 211. When the relay 237 is switchedoff, a driving signal is not applied to the ultrasonic transducers 211in the ultrasound treatment appliance 202.

On the other hand, when judging on the basis of a comparator output thatno cautery knife signal has been applied, the CPU turns on the drivecircuit 94; that is, outputs a signal to the output transformer 236, andswitches on the contacts 237 a and 237 b of the relay 237. In this case,a treatment such as coagulation or incision by ultrasonic waves can beconducted.

In this embodiment, when a cautery knife signal is detected, the relay237 is switched off. The ultrasound treatment appliance 202 is thendisconnected from the drive circuit 94 and becomes a mere treatmentappliance. The hazard that a cautery knife signal flows into the driveunit 90 and a high-frequency leakage current increases can be resolved.

Moreover, the drive circuit 94 does, unlike the one of a known system,not require various means for driving and making resonant the ultrasonictransducers while eliminating noises in a state in which a cautery knifesignal is applied. The system can therefore be simplified. In this case,ultrasonic vibrations and a cautery knife output are not suppliedsimultaneously.

According to this embodiment, a means for detecting or sensing a cauteryknife signal is included. When a cautery knife signal is detected on thebasis of an output of the detecting means, off control is given so thata driving signal triggering ultrasonic vibrations will not be output tothe probe 215. By contrast, when a cautery knife signal is not detectedon the basis of an output of the detecting means, a driving signaltriggering ultrasonic vibrations is output to the probe 215. Thus, atreatment by ultrasonic waves is enabled. Despite the simpleconfiguration, both a treatment by ultrasonic waves and a treatment by acautery knife can be conducted. Moreover, a disabling means fordisabling simultaneous execution ofboth the treatments is formed so thatboth the treatments will not be conducted simultaneously. Safety isensured.

In this embodiment, when a cautery knife signal is detected, signaloutput of the drive circuit 94 is halted (this operation is included inthe meaning of switching-off control in this specification). The outputline for a driving signal is switched off by means of the relay 237located on the output stage of the drive circuit 94. A form in whichsignal output alone is turned off or a form in which the contacts 237 aand 237 b in the relay 237 are switched off is also included in thepresent invention.

Referring to FIGS. 50 and 51, the fifteenth embodiment of the presentinvention will be described.

FIG. 50 shows the configuration of a major portion of an ultrasoundtreatment system 251 of this embodiment. A handpiece 252 in this system251 corresponds to the ultrasound treatment appliance 202 of theembodiment shown in FIG. 49 and others. A treatment electrode receptor206 located at the back end of a transducer cover 212 is not linked to aline 233 but connected to a conveying rod 220 secured to a rotor 222 viaa connection lead 253. The conveying rod 220 is electrically connectedto a holding member 217. Both a coupler 221 and distal coupler 218 areformed with insulating members.

The connection lead 253 is therefore isolated from the probe 215. In adrive unit 254 in this embodiment, an input terminal of a sense circuit92 is not linked to the line 233 but linked to an active cord 204connected to the treatment electrode receptor 206. The other componentsare identical to those of the ultrasound treatment system 201 of thefourteenth embodiment.

In this embodiment, the ability to conduct coagulation or incision byultrasonic vibrations is identical to that in the first embodiment. Theability to conduct resection by a cautery knife is realized by theholding member 217. The mechanism of sensing a cautery knife signal isthe same as that in the first embodiment except a point whether or not adetection line and a ultrasound driving signal conveying line share thesame line. The advantages of this embodiment are identical to those ofthe first embodiment.

In the fourteenth and fifteenth embodiments, a cautery knife signal isapplied to the probe 215 or holding member 217. In a handpiece 261 inFIG. 51, a cautery knife treatment electrode 262 in addition to theprobe 215 and holding member 217 are inserted in a sheath 263.

A cautery knife signal is applied to the back end (not shown) of thetreatment electrode 262. A detecting means for detecting whether or nota cautery knife signal has been output to the treatment electrode 262can detect it owing to the configuration shown in FIG. 49 or 50.

In the foregoing embodiment, a detecting means for detecting a cauteryknife signal is included in the drive unit 90. When a cautery signal isdetected on the basis of an output of the detecting means, the driveunit 90 gives control so as to prevent occurrence of ultrasonicvibrations. The present invention is not limited to this mode.Alternatively, a detecting (sensing) means for detecting whether or nota driving signal sent from a drive circuit 94 is applied to ultrasonictransducers 211 may be included for example, in a cautery knife unit. Inthis case, a cautery knife signal sent from the cautery knife unit isturned on or off according to the output of the detecting means. Thisconfiguration is also acceptable. This configuration of the sixteenthembodiment is schematically shown in FIG. 52. As shown in FIG. 52, adrive unit 90A includes the drive circuit 94. A driving signal sent fromthe drive circuit 94 is applied to the ultrasonic transducers 211.

A cautery knife unit 91A includes a cautery knife signal generatingcircuit 235, a sense circuit 92A, a control circuit 93A, a speaker 95A,and a display 96A. The cautery knife signal generating circuit 235generates a cautery knife signal. The cautery knife signal is applied toa probe 215 in an ultrasound treatment appliance 202 over an activecord.

The sense circuit 92A senses a driving signal applied to the ultrasonictransducers 211 according to the peak detection method, and sends anoutput to the control circuit 93A. The control circuit 93A judges usinga comparator or the like, which receives the output of the sense circuit92A, whether or not a driving signal is present. When it is judged thata driving signal is present, oscillation of a cautery knife signal sentfrom the cautery knife signal generating circuit 235 is halted or a lineover which an output is fed to the probe 215 is cut off Control is givenin order, at least, to prevent a cautery knife signal from being outputto the probe 215.

When judging that a driving signal has been detected, the controlcircuit 93A uses the speaker 95A to give the alarm or notify audiblythat a cautery knife signal has been cut off Moreover, the display 96Ais used for visual notification.

On the other hand, when it is judged on the basis of the output of thesense circuit 92A that a driving signal is not present, a cautery knifesignal sent from the cautery knife signal generating circuit 235 isretained in an on state in which the signal is output to the probe 215.Thus, a treatment by a cautery knife is enabled.

The operations and advantages of this embodiment are substantially thesame as those of the fourteenth embodiment.

Even in the sixteenth embodiment, the structure of the handpiece in thefourteenth embodiment or fifteenth embodiment shown in FIG. 50 may beadopted.

Different embodiments formed by combining some of the constituentfeatures of the aforesaid embodiments also belong to the presentinvention. For example, when a sensing means 239 senses a cautery knifesignal, control is given in order to halt an ultrasonic function.Alternatively, the function of the cautery knife unit may be halted.Otherwise, it may be made selective whichever of the functions ishalted. When the sensing means 239 senses a cautery knife signal, afteran audible or visual alarm is given or both of them are given, theultrasonic function or the function of the cautery knife unit may behalted for a certain period of time.

Referring to FIGS. 53 to 58, the seventeenth embodiment of the presentinvention will be described.

As shown in FIG. 53, an ultrasound treatment appliance 301 comprises atreatment unit 302, an insertion unit 303 having a channel, which willbe described later, for use in inserting the treatment unit 302 into abody cavity, and an operation unit 304 including a stationarymanipulation handle 304 a and a movable manipulation handle 304 b whichare used to manipulate the treatment unit 302. The treatment unit 302 islocated at the distal end of the insertion unit 303 and composed of aprobe 305 jutting out from the distal side of the insertion unit 303 anda holding member 306. Ultrasonic transducers, which will be describedlater, for supplying ultrasonic vibrations to the probe 305 constitutingthe treatment unit 302 are incorporated in the operation unit. Referencenumeral 307 denotes a first high-frequency current cord. 308 denotes asecond high-frequency current cord. 309 denotes an ultrasonictransducers driving cord.

As shown in FIG. 54, the treatment unit 302 located at the distal end ofthe insertion unit 303 is composed of the probe 305 jutting out from thedistal side of the insertion unit 303, and the holding member 306opposed to the probe 305. When an operator manipulates the movablemanipulation handle 304 b of the operation unit 304, a conveying member301 linking the movable manipulation handle 304 b and holding member 306advances or withdraws in the longitudinal direction. This causes theholding member 306 to open or close relative to the probe 305.

The insertion unit 303 is realized with a sheath 311 serving as anelectrically insulating means formed with a resin member made of anelectrically insulating material, for example, polysulfone or PEEK. Inthe sheath 311, a probe insertion channel 312 through which the probe305 lies and a conveying member channel 313 through which the conveyingmember 310 linked to the holding member 306 lies are included in anelectrically fully isolated manner.

As shown in FIGS. 54 to 56, a distal cover 314 having an electricalinsulation ability is fitted and locked in a distal bore of theconveying member channel 313, and is made of a resin material such aspolysulfone or PEEK similarly to the sheath 311, or of a ceramic. Theholding member 306 is attached to the distal cover 314 so that theholding member 306 can pivot freely with respect to a first pin 321.

Moreover, as shown in FIGS. 54 to 56, the holding member 306 is fixed tothe conveying member 310 for conveying a manipulation force applied tothe movable manipulation handle 304 b by means of a second pin 322 sothat the holding member 306 can pivot and slide freely. The holdingmember 306 pivots relative to the probe 305 with the first pin 321 as acenter responsively to the advancement or withdrawal of the conveyingmember 310.

Furthermore, as shown in FIGS. 54 and 56, a protective member 315 forprotecting the sheath 311 from being damaged due to the contact of theprobe 305 is placed in the distal bore of the probe insertion channel312. The protective member 315 is formed with a member having thedurability to ultrasonic vibrations, excellent heat resistivity, andelectrical insulation ability, for example, a ceramic or PTFE member.

The bare sides of the holding member 306 except the side thereof facingthe probe 305, and the portion of the distal cover 314 exposed from thesheath 311 are CVD-coated with, for example, an insulating paint madefrom PTFE or the like, or a ceramic having the electrical insulationability such as alumina ceramic. This is intended to prevent leakage ofa high-frequency current.

Similarly to the holding member 306, the bare sides of the probe 305other than those of the distal portion thereof except the side thereoffacing the holding member 306 may be subjected to CVD-coating. Thus, theleakage of a high-frequency current to a living tissue can be preventedfurther reliably. This leads to improved safety.

As shown in FIG. 57, the operation unit 304 is located at the proximalend of the insertion unit 303. Ultrasonic transducers 316 are includedin the operation unit 304. The insertion unit 303 is connected and fixedto the upper part of the stationary handle 304 a located on the distalside of the operation unit 304. The movable handle 304 b is supported bya third pin 323 on the stationary handle 304 a so that the movablehandle 304 b can pivot freely with respect to the third pin 323. Thepivot of the movable handle 304 b is conveyed to the conveying member310. The stationary handle 304 a and movable handle 304 b are made of anelectrically insulating material such as polysulfone or PEEK.

An engaging member 324 having a spherical section 324 a is fixed to theproximal end of the conveying member 310. The spherical section 324 astays in an engagement ditch 324 formed in the upper part of the movablehandle 304 b so that the spherical section 324 a can turn and slidefreely. The engagement ditch 324 has a conducting member 325 in contactwith the spherical section 324 a. The first high-frequency current cord307 used to supply a high-frequency current from a high-frequency powersupply to the holding member 306 is connected to the conducting member325. The second high-frequency current cord 308 used to supply ahigh-frequency current to the probe 305 and the ultrasonic transducerdriving cord 309 used to supply a driving current to the ultrasonictransducers 316 are extending from the back of the ultrasonictransducers 316.

A first packing 331 a is placed at an opening at which the end of theconveying member channel 313 in the sheath 311 constituting theinsertion unit 303 is located. The first packing 331 a prevents gasattributable to pneumoperitoneum from leaking out through the conveyingmember channel 313.

Moreover, a tube 326 formed with a resin member having the durability toultrasonic vibrations, excellent heat resistivity, and electricalinsulation ability; such as, a PTFE member is extending from theproximal end of the probe insertion channel 312 to an ultrasonictransducer housing 327 through the inside of the movable handle 304 b.The probe 305 is thus isolated perfectly from the other membersintervening between the probe insertion channel 312 and ultrasonictransducer housing 327.

Furthermore, the back of the ultrasonic transducer housing 327 is sealedby a second packing 332. The frontal exit for the first high-frequencycurrent cord 307 is sealed by a third packing 333.

In other words, in the ultrasound treatment appliance 301, the probe 305and ultrasonic transducers 316, and the engaging member 324, conveyingmember 310, distal cover 314, and holding member 306 are electricallyperfectly isolated from each other. The probe 305 and ultrasonictransducers 316, and the engaging member 324, conveying member 310,distal cover 314, and holding member 306 are electrically isolated fromthe outside.

As shown in FIG. 55, in the ultrasound treatment appliance 301, theholding member 306 constituting the treatment unit 302 is connected to ahigh-frequency power supply 328 via the conveying member 310, engagingmember 324, conducting member 325, first high-frequency current cord307, and holding member high-frequency current connector 307 a. On theother hand, the probe 305 constituting the treatment unit 302 isconnected to the high-frequency power supply 328 via the ultrasonictransducers 316, second high-frequency current cord 308, and probehigh-frequency current connector 308 a. Furthermore, the ultrasonictransducers 316 are connected to an ultrasonic transducer driving powersupply 329 via the ultrasonic transducer driving cord 309 and ultrasonictransducer driving connector 309 a.

A counter electrode board 330 is connected to a feedback unit in thehigh-frequency power supply 328. Thus, the holding member 306 and probe305 are electrically perfectly isolated from each other.

The operations of the ultrasound treatment appliance 301 having theforegoing structure will be described.

First, the ultrasound treatment appliance 301 is opposed to an intendedliving tissue in a living body. The movable handle 304 b of theoperation unit 304 is manipulated in order to attain an open state. Theholding member 306 is thus opened relative to the probe 305.

Next, the movable handle 304 b is manipulated in order to attain aclosed state so that the intended living tissue can be clamped by theholding member 306 and probe 305. The holding member 306 is thus closedrelative to the probe 305, whereby the living tissue is clamped.

Next, in this state, an ultrasonic transducer driving current issupplied from the ultrasonic transducer driving power supply 329 to theultrasonic transducers 316 in order to drive the ultrasonic transducers316. The ultrasonic transducers 316 then vibrate, whereby ultrasonicvibrations are conveyed to the probe 305. The ultrasonic vibrations areimposed on the living tissue in order to incise or coagulate the livingtissue.

On the other hand, when a treatment using a high-frequency current isconducted, a living tissue is clamped by the holding member 306 andprobe 305. A high-frequency current is supplied from the high-frequencypower supply 328 to either the holding member 306 or the probe 305 orboth of them. At this time, the high-frequency current is routed fromthe holding member 306 and probe 305 to the counter electrode board 330by way of the living tissue as indicated with a dashed line in FIG. 55.The high-frequency current is then fed back to the high-frequency powersupply 328, whereby the living tissue is incised or coagulated.

Incidentally, a living tissue may not be clamped by the holding member306 and probe 305. Alternatively, the probe 305 may be pressed against aliving tissue in order to impose ultrasonic vibrations. Moreover, thecounter electrode board 330 may not be employed. In this case, a livingtissue is clamped by the holding member 306 and probe 305, and ahigh-frequency current is fed to flow between the holding member 306 andprobe 305 for a treatment. Furthermore, a living tissue may not beclamped but may be ablated using the holding member 306 and probe 305.Otherwise, either the holding member 306 or probe 305 may be pressedagainst a living tissue for a treatment.

As mentioned above, the holding member and probe are electricallyperfectly isolated from each other. When a treatment using ahigh-frequency current is conducted, the treatment can be achievedsafely without a leakage of a high-frequency current.

Moreover, since a treatment by ultrasonic vibrations and a treatment bya high-frequency current can be conducted simultaneously, it is possiblethat the treatment by ultrasonic vibrations is usually adopted and thatthe treatment by a high-frequency current is utilized only when needed.In this way, two effects ofbetter hemostatic performance and preventionof excessive tissular alteration can be exerted.

Furthermore, when a high-frequency current is fed for a treatment, thecounter electrode board may be used to pass the high-frequency currentthrough a living tissue for a treatment. The counter electrode board maynot be used, wherein a living tissue is clamped by the holding memberand probe and a high-frequency current is fed to flow into the livingtissue intervening between the holding member and probe. Thus, anoperator can make his/her choice among a larger number of techniques.

Referring to FIG. 59, the relationships between an ultrasound treatmentappliance and power supplies will be described.

As illustrated, in this embodiment, a holding member high-frequencycurrent connector 371 used to supply a high-frequency current to theholding member 306 is located on the top of the operation unit 304. Theholding member high-frequency current connector 371 is connected to thehigh-frequency power supply 328 over a high-frequency current supplycord 334.

On the other hand, a probe high-frequency current and ultrasonictransducer driving current connector 372 used to supply a high-frequencycurrent to the probe 305 and an ultrasonic transducer driving current tothe ultrasonic transducers 316 is attached to a probe high-frequencycurrent and ultrasonic transducer driving current cord 335. A probesupply pin 336 and an ultrasonic transducer supply pin 337 are includedmutually independently in the probe high-frequency current andultrasonic transducer driving current connector 372, and connected tothe probe 305 and ultrasonic transducers 316 respectively.

The probe high-frequency current and ultrasonic transducer drivingcurrent cord 335 having the probe high-frequency current and ultrasonictransducer driving current connector 372 is connected to an ultrasonictransducer driving and high-frequency inclusive power supply 341 inwhich a high-frequency power supply for the probe is incorporated.

In this state, the ultrasound treatment appliance is put to use. Theconnections of the probe to the power supply and of the ultrasonictransducers to the power supply can be made at a time. The holdingmember and the probe and ultrasonic transducers can be handledseparately. This configuration is advantageous because of itsconvenience for a repair. Moreover, for supplying a high-frequencycurrent to the holding member, the high-frequency power supply can beemployed.

Referring to FIG. 60, another relationships between an ultrasoundtreatment appliance and power supplies will be described.

As illustrated, in this embodiment, a holding member and probehigh-frequency current connector 373 used to supply a high-frequencycurrent to the holding member 306 and probe 305 is attached to a holdingmember and probe high-frequency cord 338. A holding member supply pin339 and a probe supply pin 340 are included independently in the holdingmember and probe high-frequency current connector 373, and connected tothe holding member 306 and probe 305 respectively. The holding memberand probe high-frequency cord 338 having the holding member and probehigh-frequency current connector 373 is connected to the high-frequencypower supply 328. In this state, the ultrasound treatment appliance isput to use.

Owing to the foregoing configuration, the connections of ahigh-frequency current can be achieved at a time. Moreover, thehigh-frequency power supply and ultrasonic transducer driving powersupply can be handled separately.

Referring to FIG. 61, another relationships between an ultrasoundtreatment appliance and power supplies will be described.

As illustrated, in this embodiment, a holding member/probehigh-frequency current and ultrasonic transducer driving currentconnector 374 for supplying a high-frequency current to the holdingmember 306 and probe 305 and supplying an ultrasonic transducer drivingcurrent to the ultrasonic transducers 316 is attached to a holdingmember and probe and ultrasonic transducer cord 342. A holding membersupply pin 343, a probe supply pin 344, and an ultrasonic transducersupply pin 345 are included independently in the holding member/probehigh-frequency current and ultrasonic transducer driving current,connector 374, and connected to the holding member 306, probe 305, andultrasonic transducers 316 respectively. The holding member and probeand ultrasonic transducer cord 342 having the holding member/probehigh-frequency current and ultrasonic transducer driving currentconnector 374 is connected to an ultrasonic transducer driving andhigh-frequency inclusive power supply 346 having a holding member andprobe high-frequency power supply. In this state, the ultrasoundtreatment appliance is put to use. Owing to this configuration, allconnections can be made at a time and all power supplies can beintegrated into one.

Referring to FIG. 62, yet another relationships between an ultrasoundtreatment appliance and power supplies will be described.

As illustrated, in this embodiment, a holding member and probe andultrasonic transducer cord 347 having a holding member/probehigh-frequency current and ultrasonic transducer driving currentconnector 374 is detachable, from the operation unit 304. The operationunit 304 is therefore provided with a holding member/probehigh-frequency current and ultrasonic transducer driving currentconnector 375. The holding member and probe and ultrasonic transducercord 347 is provided with a holding member/probe high-frequency currentand ultrasonic transducer driving current connector 376 that isdetachable from the holding member/probe high-frequency current andultrasonic transducer driving current connector 375. The holding memberand probe and ultrasonic transducer cord is connected to an ultrasonictransducer driving and high-frequency inclusive power supply 348. Inthis state, the ultrasound treatment appliance is put to use owing tothis configuration, the ultrasound treatment appliance can be separatedfrom the cord. Replacement of a cord which is prone to a trouble such asa disconnection can be completed readily. Moreover, since work canproceed with the cord separated during cleaning and sterilization,workability improves. Furthermore, cords having different lengths can beused. A cord that is prone to a trouble such as a disconnection can bereplaced with a new one readily.

Referring to FIGS. 63 to 65, the eighteenth embodiment of the presentinvention will be described.

FIG. 63 shows the overall appearance of an ultrasound treatmentappliance. In the drawing, reference numeral 401 denotes an operationunit. A sheath 402 that is an elongated protective member is connectedto the operation unit 401. An insertion hole 405 through which aconveying rod 404 serving as a vibration conveying member for anultrasound probe 403 is passed and an insertion hole 407 through which aholding operation rod 406 is passed are defined in the sheath 402.

The conveying rod 404 connected to the ultrasound probe 403 is insertedin the insertion hole 405 in the sheath 402 so that the conveying rod404 will be freely detachable. The conveying rod 404 is incorporated inthe insertion hole 405 so that it can also turn.

The ultrasound probe 403 includes an ultrasonic oscillator 408 havingultrasonic oscillatory devices coupled to the proximal end of theconveying rod 404. Ultrasonic vibrations oscillated by the ultrasonicoscillator 408 are conveyed to a treatment section 409 through theconveying rod 404.

A holding member 410 with a holding butt is attached to the distal endof the sheath 402 so that the holding member 410 can pivot with an axispin 411 as a supporting point. The holding member 410 is positioned sothat the holding member 410 will adjoin the distal portion of theconveying rod 404 and be opposed to the top of the distal portionthereof. The distal end of the holding operation rod 406 is attached tothe holding member 410 at a position near the proximal end of theholding member 410 and off the supporting point of the axis pin 411.

Owing to the foregoing structure, when the holding operation rod 406 isadvanced, the holding member 410 pivots toward the distal end of theconveying rod 404 and closes. By contrast, when the holding operationrod 406 is withdrawn, the holding member 410 opens. FIGS. 63A, 63B, and64 show a state in which the holding member 410 is open. The operationunit 401 has an open/close manipulation lever 412 serving as amanipulator for advancing or withdrawing the holding operation rod 406.

The distal portion of the conveying rod 404 has a much smaller diameterthan the other portion. The tip of the distal portion constitutes thetreatment section 409 that is a section jutting out from the distal endof the sheath 402. The treatment section 409 jutting out from the distalend of the sheath 402 is opposed to a holding butt 410 a of the holdingmember 410. The treatment section that juts out from the distal end ofthe sheath 402 has a coagulation surface 413 used to coagulate a livingtissue formed on one side thereof. An incision area 414 used to incise aliving tissue is formed on the opposite side of the treatment section.In other words, the coagulation surface 413 that is blunt and round inshape is formed on the upper side in FIG. 64, and the incision area 414is formed as a knife-like sharp edge on the lower side therein.

In the conveying rod 404, engagement sections 415 and 416 that are flatsteps are formed on the top and bottom of the distal part of thelarge-diameter portion that is continuous to a small-diameter distalportion via the steps. At least one alignment pin 417 traversing theconveying rod insertion hole 405 in the sheath 402 is located, in arelatively upper area of the insertion hole 405. The engagement section415 or 416 is engaged with the alignment pin 417. Herein, the onealignment pin 417 is installed in the upper area. Only the engagementpin 415 or 146 that has been oriented upward by turning the conveyingrod 404 engages with the alignment pin 417. The coagulation surface 413or incision area 414 associated with the engagement section 415 or 146engaged with the alignment pin 417 is oriented upward and opposed to theholding butt 410 a of the holding member 410.

Furthermore, a fragment-like guard member 420 jutting out to the sameextent as the treatment section 409 of the ultrasound probe 403 isformed as part of the sheath 402 by stretching the lower part of thedistal end of the sheath 402. The guard member 420 is located just underthe treatment section 409 jutting out from the sheath 402 in order tocover the sharp blade of the incision area 414 opposed to the guardmember 420. In other words, the guard member 420 is located on theopposite side of the treatment section 409 relative to the holdingmember 410 and covers the side of the treatment section 409 not facing aliving tissue to be treated.

On the other hand, the operation unit 401 has a stopper lever 421 thatwhen the conveying rod 404 joined with the ultrasound probe 403 isinserted in the sheath 402, stops the ultrasound probe 403. When thestopper lever 421 is raised as shown in FIG. 63A, insertion or removalof the ultrasound probe 403 is enabled. When the stopper lever 421 isleveled off, removal of the ultrasound probe 403 is disabled.

Next, the operations of the ultrasound treatment appliance in use willbe described.

First, the orientation of the treatment section 409 of the conveying rod404 is defined according to the purpose of use. FIG. 64 shows a state inwhich a living tissue is coagulated. The coagulation surface 413 of thetreatment section 409 formed as the distal portion of the conveying rod404 faces upward and is opposed to the holding member 410. For incisinga living tissue, the conveying rod 404 is turned 180.degree. so that theincision area 414 of the treatment section 409 will face upward and beopposed to the holding member 410.

The change of the states can be achieved as described below. That is tosay, the stopper lever 421 is raised as shown in FIG. 63A, and theconveying rod 404 is withdrawn. The engagement section 415 or 146engaged with the alignment pin 417 is thus escaped from the alignmentpin 417. This enables the conveying rod 404 to turn freely. When thewhole ultrasound probe 403 is turned 180.degree. as shown in FIG. 63A,the orientation of the treatment section 409 is inverted. Consequently,the orientations of the coagulation surface 413 and incision area 414are switched. Thereafter, the conveying rod 404 is advanced so that theupper engagement section 415 will be engaged with the alignment pin 417.The orientation of the conveying rod 404 is thus aligned and fixed atthat position. The stopper lever 421 is leveled off as shown in FIG.63B. Consequently, the ultrasound probe 403 is fixed to the operationunit 401.

Next, the operation for coagulating a living tissue will be described.

For direct surgery or surgery under laparoscopic observation, a trocar,endoscope, or the like is used to introduce the ultrasound treatmentappliance into a body cavity. A living tissue 425 is then, as shown inFIG. 65, clamped by the holding member 410 and coagulation surface 413.Thereafter, ultrasonic waves are oscillated, and vibrations are conveyedto the treatment section 409 through the conveying rod 404. The livingtissue 425 clamped by the holding member 410 and the coagulation surface413 of the treatment section 409 making ultrasonic vibrations iscauterized with frictional heat resulting from the vibrations, and thuscoagulated.

During the coagulation, the incision area 414 opposite to thecoagulation surface 413 is covered by the guard member 420 and preventedfrom touching a normal living tissue 426.

As mentioned above, it will not take place that the normal living tissue426 is cauterized while being invisible to an operator. There is nopossibility that when ultrasonic vibrations are not produced, the sharpincision area 414 touches and injures a living tissue. Thus, auser-friendly ultrasound treatment appliance can be provided.

Referring to FIG. 66, the nineteenth embodiment of the present inventionwill be described.

This embodiment is basically identical to the aforesaid eighteenthembodiment. The distal portion of the sheath 402 is devoid of the guardmember 420. Part of the distal portion is cut out. The distal portionhas a length permitting the distal portion to reach the root of thetreatment section 409 of the ultrasound probe 403.

On the other hand, the circumference of the sheath 402 is covered withan outer sheath 430. A guard member 431 having the same ability as theguard member 420 and jutting out to the tip of the treatment sectionprovided as the distal portion 409 of the ultrasound probe 403 is formedat the distal end of the outer sheath 430.

The outer sheath 430 and sheath 402 are engaged with each other and cantherefore be separated from each other. In other words, the outer sheath430 can be detached from the sheath 402. For a region in which the guardmember 431 is needed and observation is hard to do, the ultrasoundtreatment appliance is used with the outer sheath 430 attached. For aregion in which a better field of view is ensured and, especially, theguard member 431 is unnecessary, the ultrasound treatment appliance isused to conduct a treatment with the outer sheath 430 detached. Anoperator can determine whether or not to use the guard member 431 andproceed with work in a minimum necessary optimal state.

Referring to FIG. 67, the twentieth embodiment of the present inventionwill be described.

In this embodiment, a guard member 440 having the same ability as theaforesaid guard members is attached under the distal portion of thesheath 402 so that the guard member 440 can slide freely along thelongitudinal axis of the sheath 402. A sliding engagement section havinga concave part 441, with which a convex part formed on the guard member440 is engaged so that the guard member 440 can slide freely, is formedas a sliding mechanism.

After the convex part is engaged with the concave part, the guard member440 can freely slide back and forth on the sheath 402 as indicated witharrows in FIG. 67. For use, the guard member 440 is advanced and juttedout. When not used, the guard member 440 is withdrawn and escaped underthe sheath 402. Temporary lock may be attained using frictional forceinduced between the guard member 440 and the concave area 441 with whichthe guard member 440 engages or using a click stop or the like.Alternatively, any other locking means may be used.

An operator may or may not attach the guard member 440 as he/she likes.Moreover, the operator should merely slide the guard member. The usedand unused states of the guard member can be switched readily withoutthe labor for detaching the outer sheath in the second embodiment.

Needless to say, the guard member 440 can not only be slided but also bedetached from the sheath 402.

Referring to FIG. 68, the twenty-first embodiment of the presentinvention will be described.

In this embodiment, in an ultrasound treatment system, ultrasonicoscillations can be operated by both a hand switch 451 formed on theoperation unit 401 of an ultrasound treatment appliance and a footswitch 452 independent of the hand switch 451.

An ultrasonic oscillator in the ultrasound probe 403 is connected to amain unit 453 including an ultrasonic oscillatory signal source. Thehand switch 451 and foot switch 452 are also connected to the main unit453. On-off control of ultrasound oscillations can be achieved usingeither the hand switch 451 or foot switch 452. When the hand switch 451is used, an on-off operation can be performed in parallel withmanipulation of forceps by the operation unit 401. The ultrasoundtreatment appliance has the same structure as those described in otherembodiments.

Referring to FIG. 69, the twenty-second embodiment of the presentinvention will be described.

This embodiment attempts to properly perform the on-off operationofultrasonic oscillations in an ultrasound treatment system according tocoagulation or incision of a living tissue.

To be more specific, the operation unit 401 of an ultrasound treatmentappliance is provided with a pair of handles; a frontal handle 461attached on a stationary basis and the open/close manipulation lever412. A thumb is rested on the open/close manipulation lever 412 servingas a rear handle, and any other fingers are rested on the frontal handle461 in order to grip the frontal handle 461. A pressure switch 462realized with a pressure sensor or the like that conducts withapplication of a certain amount of pressure is formed on the portion ofthe frontal handle 461 gripped by a hand. A signal sent from thepressure switch 462 is sent to a main unit 465 including an ultrasonicoscillatory signal source over a signal line 464 united with a powercable 463. A vibration occurrence control means in the main unit 465turns on or off ultrasound oscillations.

In other words, when an object tissue on the treatment section 409 ofthe ultrasound treatment appliance is clamped by manipulating the pairof manipulation handles; that is, the frontal handle 461 and open/closemanipulation lever 412, a certain amount of pressure is applied to thepressure switch 462. After the living tissue is clamped, if the pair ofmanipulation handles is gripped more strongly, the pressure switch 462produces an on signal. Consequently, ultrasonic waves are oscillated toenable coagulation or incision of the living tissue. After a treatmentis completed, a hand is released or force is alleviated. Oscillationsare then automatically turned off. Thus, a more precise force can beexerted.

According to this embodiment, oscillations can be produced only whenneeded. It becomes unnecessary to press the foot switch or hand switchevery time. An incorrect press of the switch will therefore not occur.Consequently, a surgical procedure can be conducted more safely andaccurately. Since excessive cords are excluded, it becomes easy to makepreparations and straighten things up.

Referring to FIGS. 70A and 70B, the twenty-third embodiment of thepresent invention will be described.

This embodiment also attempts to properly perform the on-off operationof ultrasonic oscillations in an ultrasound treatment system accordingto coagulation or incision of a living tissue.

FIGS. 70A and 70B are explanatory diagrams graphically showing aswitching mechanism incorporated in an ultrasound treatment appliancesimilar to the aforesaid one.

Specifically, the holding member 410 is, as mentioned above, opened orclosed by manipulating the handles of the operation unit 401. Theoperation rod 406 is connected to the open/close manipulation lever 412serving as the rear handle at a supporting point 471 in the operationunit 401. A supporting point 472 is defined in the middle of an arm ofthe open/close manipulation lever 412. The supporting point 472 isincluded in a sliding member 473. The sliding member 473 is stowed in aguide section 474 formed in the operation unit 401 so that the slidingmember 473 can slide freely. Normally, the sliding member 473 is pressedto the end of the guide section 474 by an elastic constraining meanssuch as a coil spring 475 or blade spring. On the sliding member 473, aon-off button 476 for a switch is located on the opposite side of thesliding member 473 relative to the supporting point 472.

When the open/close manipulation lever 412 serving as a rear handle ismoved forward as shown in FIG. 70A, the operation rod 406 moves forward.The holding member 410 closes to clamp an object living tissue 477 incooperation with the treatment section 409 of the ultrasound probe 403.Thereafter, when more force is applied, the supporting point 472 movesalong with the sliding member 473 in a direction in which the coilspring 475 is contracted. Consequently, the on/off button 476 for theswitch is pressed. This activates the switch. Ultrasonic waves areoscillated, thus enabling the treatment of the object tissue. When forceis alleviated, the supporting point 472 returns to the originalposition. The on/off button 476 is set to an off state.

Thus, oscillations can be produced only when needed. It becomesunnecessary to press the foot switch or hand switch every time.Moreover, an incorrect press of the switch will not occur. A surgicalprocedure can therefore be conducted more safely and reliably. Sinceexcessive cords are excluded, it becomes easy to make preparations orstraighten things up.

Referring to FIG. 71, the twenty-fourth embodiment of the presentinvention will be described.

This embodiment also attempts to properly perform the on-off operationof ultrasonic oscillations in an ultrasound treatment system accordingto coagulation or incision of a living tissue.

To be more specific, in this embodiment, as mentioned above, a pressuresensor, for example, a strain gauge 481 is affixed to the holding member410 of an ultrasound treatment appliance. Owing to this structure, aclamping force can be detected more accurately. When clamping force isapplied, the holding member 410 is strained. When the strain reaches acertain value, ultrasonic waves are oscillated in response to a signalindicating the strain.

A pressure sensor may be attached to the holding butt 410 a of theholding member 410 or to a holding plane 410 b thereof. It is alsopossible to attach a piezoelectric member to the holding plane 410 b inorder to sense a pressure. Using the structure for sensing a pressuredirectly, a clamped state can be detected more reliably than in anyother embodiment.

Referring to FIGS. 72 to 74, the twenty-fifth embodiment of the presentinvention will be described.

As shown in FIG. 72, an ultrasound treatment appliance 501 of thisembodiment comprises a grip unit 502 including ultrasonic transducers,an operation unit 503 fixed to the grip unit 502, an elongatedultrasound probe (hereinafter a probe) 504 coupled with the ultrasonictransducers in the grip unit 502 in order to convey ultrasonicvibrations, and a sheath 505 for covering the probe 504. Referencenumeral 506 denotes a distal member constituting a stationary section ofa treatment unit distal to the probe 504. 507 denotes a holding memberconstituting a movable section of the treatment unit which is opposed tothe distal member 506.

As shown in FIG. 73, the distal member 506 has a slit-like notch 506 ain the distal center thereof. The holding member 507 has a widthpermitting the holding member 507 to intrude into the slit-like notch ofthe distal member 506.

The tips of the distal member 506 and holding member 507 are curved tofacilitate clamping of a living tissue.

As shown in FIG. 74, holding surfaces 507 a are formed on the tip of theholding member 507 and holding surfaces 506 b are formed on the tip ofthe distal member 506, so that the holding surfaces 507 a and 506 a willbe opposed to each other. Specifically, the tip of the holding member507 has a convex part and forms the holding surfaces 507 a. Theslit-like notch 506 a of the distal member 506 serving as a distalmember has a concave part and forms the holding surfaces 506 b.

Next, the operations of the ultrasound treatment appliance 501 havingthe foregoing structure will be described.

In FIG. 72, when the operation unit 503 is manipulated, the holdingmember 507 gradually closes relative to the distal member 506 serving asa distal member. Consequently, a living tissue 511 is clamped.Specifically, at this time, the living tissue 511 is clamped by theholding surfaces 507 a of the holding member 507 and the holdingsurfaces 506 a of the distal member 506.

Next, in this state, the ultrasonic transducers incorporated in the gripunit 502 are vibrated. Ultrasonic vibrations stemming from theultrasonic transducers then propagate the probe 504 and are conveyed tothe distal member 506 clamping the living tissue 511. The distal member506 develops frictional heat due to the ultrasonic vibrations. Thus, theliving tissue 511 clamped by the holding member 507 and distal member506 is coagulated.

Speaking in more detail, the portion of the tissue clamped by theholding surfaces 507 a and holding surfaces 506 b shown in FIG. 74 iscoagulated especially efficiently.

Next, when the grip unit 502 is gripped more intensively, the holdingmember 507 intrudes into the slit-like notch 506 a of the distal member506 serving as a distal member, and thus incises the living tissue 511.

As mentioned above, in the ultrasound treatment appliance 501 of thisembodiment, the holding surfaces 507 a of the holding member 507cooperate with the holding surfaces 506 b of the distal member 506 inreliably clamping the living tissue 511. The living tissue 511 iscoagulated with frictional heat resulting from ultrasonic vibrationsconveyed to the distal member 506. The holding member 507 is intrudedinto the slit-like notch 506 a of the distal member 506 serving as adistal member in order to incise the living tissue 511. The livingtissue 511 can therefore be incised reliably even if the living tissue511 is a ligament containing lots of fibers or the like.

The living tissue 511 is clamped by the holding surfaces 507 a of theholding member 507 and the holding surfaces 506 a of the distal member506. The margins of an incision area of the living tissue 511 are thencoagulated. Bleeding can therefore be prevented during incision.

Furthermore, since incision and coagulation can be executed on oneplane, it becomes possible to shorten a surgery time.

As shown in FIG. 74, in this embodiment, the tip of the holding member507 has a convex part and forms the holding surfaces 507 a. Theslit-like notch 506 a of the distal member 506 serving as a distalmember has a concave part and forms the holding surfaces 506 b. Thepresent invention is not limited to this structure but may apply to areverse structure. Specifically, the tip of the distal member 506serving as a distal member may have a convex part and form holdingsurfaces, and a slit-like notch formed in the holding member 507 mayhave a concave part and form holding surfaces. Even this structureprovides the same advantages as those mentioned above.

Moreover, the holding member 507 and the distal member 506 serving as adistal member can be replaced with another ones and are not limited tothe foregoing shapes. Furthermore, the distal member 506 serving as adistal member may be shaped as mentioned above by directly machining theprobe 504. Even this structure provides the aforesaid advantages.

Referring to FIG. 75, the twenty-sixth embodiment of the presentinvention will be described.

This embodiment is substantially identical to the twenty-fifthembodiment. Only a difference will be described. The same components areassigned the same reference numerals, and the description of thecomponents will be omitted.

As shown in FIG. 75, the holding member 507 is structured so that theholding member 507 can advance or withdraw freely in the same directionas a vibrating direction of the distal member 506. The tip of theholding member 507 on the side of the distal member 506 has a convexpart 521. In contrast, the distal member 506 has a concave part 522serving as a guide for the convex part 521 of the holding member 507.The convex part 521 of the holding member 507 advances or withdrawsalong the concave part 522 serving as a guide. In this embodiment,holding surfaces 507 a are formed on the margins of the convex part 521of the holding member 507. Holding surfaces 506 b are formed on an innerside of the distal member 506 opposed to the holding surfaces 507 a. Theother components are identical to those in the twenty-fifth embodiment.

In this embodiment, when the operation unit 503 is manipulated, as shownin FIG. 75, the convex part 521 of the holding member 507 advances orwithdraws along the concave part 522 serving as a guide. The holdingsurfaces 507 a on the margins of the convex part 521 and the holdingsurfaces 506 b of the distal member 506 having the similar shape as theone in the twenty-fifth embodiment cooperate with each other in clampingthe living tissue 511. The living tissue 511 is then coagulated withfrictional heat resulting from ultrasonic vibrations conveyed to thedistal member 506. The holding member 507 is intruded into the slit-likenotch 506 a of the distal member 506 serving as a distal member in orderto incise the living tissue 511. When the grip unit 502 is grippedfurther intensively, the convex part 521 of the holding member 507intrudes into the slit-like notch 506 a of the distal member 506 servingas a distal member so as to incise the living tissue 511. The otheroperations are identical to those of the twenty-fifth embodiment.

As mentioned above, this embodiment has the same advantages as thetwenty-fifth embodiment. Moreover, the holding surfaces 507 a on themargins of the convex part 521 of the holding member 507 are used toclamp the living tissue 511. Thus, larger holding surfaces can beensured for clamping the living tissue 511. This results in morereliable coagulation.

Incidentally, the guide for the convex part 521 may be formed on asheath 505 shown in FIG. 72 but may not be the concave part 522 formedto advance or withdraw the holding member 507.

Referring to FIG. 76, the twenty-seventh embodiment of the presentinvention will be described.

As illustrated, a probe 216 of an ultrasonic incision/coagulation unit202, in which transducers for generating ultrasonic vibrations so as toenable coagulation and incision are incorporated, in an ultrasoundtreatment system 600 of this embodiment is, as shown in FIGS. 38A and41, formed with a pipe member having a through hole 216 a. The throughhole 216 a bored in the probe 216 communicates with a bore of a suctionbase 601 jutting from the back end of the transducer cover 212 that is ahandpiece by way of through holes bored in the transducers inside thetransducer cover 212.

One end of a suction tube 602 is joined with the suction base 601. Theother end of the suction tube 602 is connected to a suction pump 605 viaa suction vial 603 and communication tube 604.

By the way, a perfusion base 606 is jutting from the outer circumferenceof the transducer cover 212. One end of a perfusion tube 607 is joinedwith the perfusion base 606, and the other end thereof is connected to aperfusion tank 609, in which a perfusion fluid such as physiologicalsaline is preserved, by way of a roller pump 608. The bore of theperfusion base 606 communicates with the bore of the sheath 229.

The other components are identical to those in the fourteenthembodiment. The same reference numerals will be assigned to the samemembers. The description of the members will be omitted.

Since the ultrasound treatment system 600 has the foregoing components,when a living tissue clamped by the probe 216 and holding member 217 iscrashed by ultrasonic vibrations, the suction pump 605 is driven so thatthe crashed tissue can be sucked through the through hole 216 a of theprobe 216 and evacuated to the suction vial 603. Moreover, when theroller pump 608 is driven, the perfusion fluid such as physiologicalsaline preserved in the perfusion tank 609 can be jetted to a region tobe treated or the like through a distal opening 229 a by ways of thebore of the sheath 229.

An ultrasonic coagulation/incision function and suction function make itpossible to continuously carry out the sequential work of exposing ablood vessel and then coagulating or incising the blood vessel or atissue. This contributes to improvement of maneuverability and a greatdecrease in surgical operation time.

The twenty-eighth embodiment of the present invention will be describedwith reference to FIG. 77 to FIG. 84.

This embodiment relates to a handpiece 601 of an ultrasonicincision/coagulation system that is an example of ultrasound treatmentsystems. The handpiece 601 includes an external unit 604 and an internalunit 605 shown in FIG. 78A. The internal unit 605 is mounted in theexternal unit 604 so that the internal unit 605 can be dismountedfreely.

Moreover, the external unit 602 is, as shown in FIG. 78B, composed of anelongated cylindrical insertion-unit sheath 602 and a cylindricalholding-unit sheath 603. The insertion-unit sheath 602 serves as aninsertion unit protecting member, and the holding-unit sheath 603 isattached to the proximal end of the insertion-unit sheath 602.Furthermore, the holding-unit sheath 603 is provided with a clampingmember operating means 613 composed of a stationary handle 611 andmovable operation handle 612.

The stationary handle 611 is fixed to the holding-unit sheath 603, whilethe movable operation handle 612 is pivoted to the holding-unit sheath603 using a pin 610. Furthermore, the stationary handle 611 and movableoperation handle 612 have finger-rest ring portions 611 a and 612 arespectively.

Moreover, a turning knob 617 is, as shown in FIG. 81A, fixed to theproximal part of the insertion-unit sheath 602. A cylindrical couplingportion 617 a is projected from the back end of the turning knob 617.Furthermore, the distal end of the holding-unit sheath 603 is coupled tothe coupling portion 617 a of the turning knob 617 so that the turningknob 617 can be turned freely. The proximal part of the insertion-unitsheath 602 is attached to the holding-unit sheath 603 via the couplingportion 617 a of the turning knob 617, so that the insertion-unit sheath602 can be freely turned about the axis of the holding-unit sheath 603.The turning knob 617 realizes an operating means for turning theinsertion-unit sheath 602 about the axis of the holding-unit sheath 603.

Moreover, the internal unit 605 includes an ultrasonic transducer unit621 and a clamping member unit 622. The ultrasonic transducer unit 621has an ultrasonic transducer that is not shown, a horn 624, and a probe625 serving as a vibration transmitting member. The ultrasonictransducer is locked in a cover sheath 623 of the handpiece 601.Furthermore, an ultrasonic treatment portion 626 is formed as the distalpart of the probe 625 ultrasonic vibrations generated by the ultrasonictransducer are intensified by the horn 624 and transmitted to theultrasonic treatment portion 626 that is the distal part of the probe625.

Titanium, aluminum, or an alloy thereof that offers an excellentacoustic effect and has a superb nature acceptable by a living body isoften made into the horn 624 for transmitting vibration generated by theultrasonic transducer, and the probe 625.

Moreover, a screw 627 is, as shown in FIG. 80, threaded in the proximalpart of the probe 625. Using the screw 27, the proximal part of theprobe 625 is screwed to the distal part of the horn 624. The probe 625serving as a vibration transmitting member is realized with asubstantially straight rod having a tapered horn 628 formed as anintegral part thereof but not having a stepped portion or a groove-likesmall-diameter portion. Owing to this structure, the probe 625 enjoysintensified strength.

Moreover, the slender ultrasonic treatment portion 626 is formed as theextremely distal part of the probe 625. The ultrasonic treatment portion626 is a portion serving as a stationary blade 629. The stationary blade629 may be a blade having a round cross section. Preferably, thestationary blade 629 should be made available in various shapes, suchas, a rectangular blade having a narrow width, an elliptic blade, and atriangular blade. This is preferred from the viewpoint of improvingtreatment efficiency and designing a treatment work unit compactly.Moreover, blades having various shapes or forms other than the roundblade are often adopted to balance the operation of incision and theoperation of coagulation.

Incidentally, the stationary blade 629 may not be formed as an integralpart of the probe 625 but may be formed as a separate member. Theseparate member may be coupled to the probe 625 using a screw or thelike, so that the stationary blade 629 can be replaced with anotherstationary blade 629 having a different shape.

Moreover, the clamping member unit 622 has, as shown in FIG. 79A, ametallic movable blade (clamping member) 641 and an operation rod 634(clamping member driving means). The movable blade 642 is opposed to thestationary blade 629, and serves as a jaw that clamps a living tissue incooperation with the stationary blade 629 or frees the living tissue.The operation rod 634 serves as an operation force transmitting memberfor driving the movable blade 641 to open or close it.

Furthermore, the clamping member unit 622 has, as shown in FIG. 80A,FIG. 80B, and FIG. 80C, a plurality of spacers 631 arranged at nodes nof ultrasonic vibrations. A clamping member support base 632 that is onespacer is located at the position of the extremely distal node n ofultrasonic vibrations in the probe 625.

Moreover, a groove 635 in which the operation rod 634 is fitted andretained is cut in the top of each spacer 631. An outer locking member636 formed with a small-diameter pipe is, as shown in FIG. 60, fitted ineach groove 635. The operation rod 634 is inserted into the outerlocking members 636 and immobilized. In other words, the operation rod634 is fitted along the axes of the spacers 631 in the spacers 631 otherthan the clamping member support base 632 that is the extremely distalspacer.

The spacers 631 should merely retain the operation rod 632 for fear theoperation rod may be displaced from the positions of the nodes n ofultrasonic vibrations in the probe 625. An alternative attaching meansfor the spacers 631 is such that the spacers 631 are fixed to theoperation rod 634 directly or via the outer locking members 636.Alternatively, a locking means may be adopted so that the spacers 631will not be fixed to the operation rod 634 but will be merely retainedat the positions of the nodes of ultrasonic vibrations so as not to bedisplaced therefrom. The spacers 631 are thus positioned and fixed tothe operation rod 634. This obviates the necessity of creating concaveand convex parts, which are used for positioning the spacers 631, in theprobe 635. This results in the simpler structure and reduced costs.Moreover, the strengths of the probe 625 and spacers 631 can beimproved.

Moreover, a through hole 637 in which the probe 625 is inserted andretained, and an attachment/detachment slit 638 are formed in the lowerpart of each spacer 631. The probe 625 is inserted into the throughholes 637 so that it can slide along the axes thereof. The spacers 631are made of a fluoroplastic material offering excellent slidingsmoothness, such as, so-called Teflon, and thus formed as members thatrub against the probe 625.

Moreover, the proximal end of the movable blade 641 is pivoted to theclamping member support base 632, which is the extremely distal spacer,using a pin 642. Moreover, the distal part of the operation rod 634 iscoupled to the proximal part of the movable blade 641 so that theoperation rod 634 can be turned freely.

Moreover, a sliding cylinder 616 shown in FIG. 80 is coupled to theproximal end of the operation rod 634. The sliding cylinder 616 isinserted into the holding-unit sheath 603 so that the sliding cylinder616 can freely slide back and forth. A passage hole 643 through whichthe probe 625 is passed is bored in the axial center of the slidingcylinder 616.

Moreover, an annular groove 644 by which the sliding cylinder 616 iscoupled to the movable operation handle 612 is cut in the outercircumference of the sliding cylinder 616. Windows 614 through which themovable operation handle is coupled are located on both sides of theflank of the holding-unit sheath 603. Locking pins (locking members) 615piercing the distal parts of the movable operation handle 612 areinserted through the windows 614. Furthermore, the distal ends of thelocking pins 615 are fitted and locked in the annular groove 644 of thesliding cylinder 616. When the movable operation handle 612 is turnedwith the pin 610 as a center, the sliding cylinder 616 is slid back andforth by means of the locking pins 615. The operation rod 634 is slidback and forth together with the sliding cylinder 616. This causes themovable blade 641 opposed to the stationary blade 629 to open or close.

The locking pins 615 are screwed to the distal parts of the movableoperation handle 612. By turning the heads 615 a of the locking pins615, the tips of the locking pins 615 are jutted to be fitted in theannular groove 644 of the sliding cylinder 616. On the contrary, thetips of the locking pins 615 are withdrawn to be freed from the annulargroove 646 of the sliding cylinder 616.

Moreover, the movable blade 641 has, as shown in FIG. 82 and FIG. 83A, acurved surface 652 formed on its side coming into contact with thestationary blade 629 of the probe 625. The curved surface 652 comes intocontact, directly with the stationary blade 629. The curved surface 652should preferably be designed to have its contour varied depending onthe shape of the stationary blade 629. Furthermore, the movable blade641 has wavy tooth-like portions 654 formed on both sides of the curvedsurface 652 that comes into direct contact with the stationary blade629. The tooth-like portions help the movable blade 641 and stationaryblade 629 to clamp living tissue reliably. The curved surface 652 of themovable blade 641 and the tooth-like portions 652 should preferably bemade of Teflon or any other material offering excellent slidingsmoothness.

Moreover, a circular flange 646 is formed at the position of theextremely distal node n of ultrasonic vibrations in the distal part ofthe probe 625. A fitting groove 647 shaped in line with the flange 646is cut in the lower inner surface of the clamping member support base632 that is the extremely distal spacer for supporting the movable blade641. As shown in FIG. 79C, the flange 646 is fitted and locked in thefitting groove 647 of the clamping member support base 632. The probe625 is therefore held in the clamping member support base 632 to beturnable.

The clamping member support base 632 is therefore mounted so that it canbe turned about the axis of the probe 652 together with theinsertion-unit sheath 602. The orientation of the stationary blade 629relative to the movable blade 641 may assume any angle within360.degree. The movable blade 641 can be turned for use so that it canbe used easily by an operator.

Moreover, as shown in FIG. 81A, a projecting portion 712 is projectingfrom one side of the distal end of the sliding cylinder 616 with respectto the center axis of the sliding cylinder 616. An axial center hole 617b is, as shown in FIG. 81B, bored in the axial center of the turningknob 617. The probe 625 and operation rod 634 are passed through theaxial center hole 617 b. Furthermore, a fitting groove 617 c shaped inline with the projecting portion 712 of the sliding cylinder 616 is cutin one side of the axial center hole 617 b. The projecting portion 712of the sliding cylinder 616 is fitted into the fitting groove 617 c ofthe turning knob 617, thus preventing the sliding cylinder 616 andturning knob 617 from relatively turning about the axes thereof. Theprojecting portion 712 of the sliding cylinder 616 is turned whilefitted in the fitting groove 617 c of the turning knob 617. All turnablecomponents except the insertion-unit sheath 602 and the probe 625included in the internal unit 605 can therefore be turnedsimultaneously.

Furthermore, as shown in FIG. 83B, a locking end surface 648 that issubstantially flat is formed as the bottom of the clamping membersupport base 632. The locking end surface 648 is locked with ananti-turn member 649 fixed to the inner surface of the insertion-unitsheath 602. When the insertion-unit sheath 602 and clamping membersupport base 632 are turned about the axes thereof, they turn togetherwith the locking member for the turning knob 617. The internal unit 605will therefore not be twisted.

Moreover, an anti-swing member 650 made of a material permitting smoothsliding, such as, so-called Teflon Is formed as an integral part of theclamping member support base 632. This is intended to prevent thestationary blade 629 of the probe 625 from swinging. The anti-swingmember 650 bears a horn 628 formed as the distal part of the probe 625,and prevents a warp.

Moreover, in this embodiment, a through hole 710 is bored along theaxial centers of the ultrasonic transducer, horn 624, and probe 625included in the ultrasonic transducer unit 621. Furthermore, a suctionbase 702 communicating with the through hole 710 is jutted from the backend of the ultrasonic transducer unit 621. One end of a suction tube 703is coupled to the suction base 702.

Moreover, a ring-shaped channel coupling member 700A is mounted on theouter circumference of the distal part of the cover sheath 623 so thatthe channel coupling member 700A can be turned. A liquid is supplied tothe lumen of a cover sheath 623 through the channel coupling member700A. A perfusion base 700 is jutted from the channel coupling member700A. One end of a perfusion tube 701 is coupled to the perfusion bass700.

Furthermore, a penetrating perfusion hole is bored in the cover sheath623 inside the channel coupling member 700A. A liquid supplied over theperfusion tube 701 is fed into the channel coupling member 700A throughthe perfusion base 700. The liquid is then supplied to the inside of thecover, sheath 632 through the perfusion hole bored inside the channelcoupling member 700A.

Moreover, a perfusion channel is formed between the insertion-unitsheath 602 and probe 625. Herein, a groove 631 a for creating a path is,as shown in FIG. 80, cut in the flank of each spacer 631. Supply of aliquid is thus carried out smoothly. Furthermore, a key groove 711 is,as shown in FIG. 79C, penetrating through the clamping member supportbase 632. This helps a perfusive liquid to flow smoothly.

FIG. 84 shows, similarly to FIG. 76, the outline overall configurationof an ultrasonic incision/coagulation system. In FIG. 84, there areshown an ultrasonic treatment power supply apparatus 721 and ahigh-frequency treatment power supply apparatus 714.

Moreover, ends of an ultrasonic driving power cord 655 andhigh-frequency treatment power cord 656 which are shown in FIG. 77 arecoupled to the back end of the handpiece 601. The other end of theultrasonic driving power cord 655 is connected to the ultrasonictreatment power supply apparatus 721. The other end of thehigh-frequency treatment power supply cord 656 is spliced to a powercord 713 extending from the high-frequency treatment power supplyapparatus 714. A foot switch 722 used to control ultrasonic waves isconnected to the ultrasonic treatment power supply apparatus 721. A footswitch 718 used to control a high-frequency voltage is connected to thehigh-frequency treatment power supply apparatus 714. Furthermore, acounter electrode plate 720 is connected to the high-frequency treatmentpower supply apparatus 714 over a lead 719.

As shown in FIG. 84, the other end of the perfusion tube 701 coupled tothe perfusion base 700 of the handpiece 601 is coupled to a perfusiontank 724 via a roller pump 723. Physiological saline or any otherperfusive liquid is reserved in the perfusion tank 724. Thus, aperfusing means is realized. Specifically, when the roller pump 723 isdriven, physiological saline or the like in the perfusion tank 724 issupplied over the perfusion channel created between the insertion-unitsheath 602 and probe 625.

Furthermore, the other end of the suction tube 703 coupled to thesuction base 702 is coupled to a suction pump 716 by way of a suctionbin 715 and communication tube 717. Thus, a sucking means is realized.Specifically, a living tissue crushed by ultrasonic violations is suckedover the through hole 710 of the probe 625 by driving the suction pump716, and discharged into the suction bin 715.

Next, a description will be made of the operations of the ultrasonicincision/coagulation system having the foregoing components.

When the ultrasonic incision/coagulation system of this embodiment is inuse, the movable operation handle 612 pivots with the pin 610 as acenter relative to the stationary handle 611. This causes the movableblade 641, which is opposed to the stationary blade 629 that is theextremely distal part of the probe 621, to open dr close. A livingtissue is clamped by the stationary blade 629 and movable blade 641, andcrushed by ultrasonic vibrations. At this time, the suction pump 716 isdriven in order to suck the crushed living tissue over the through hole710 of the prove 625. The crushed living tissue can then be dischargedinto the suction bin 715.

Moreover, when the roller pump 723 is driven, physiological saline orany other perfusive liquid reserved in the perfusion tank 724 issupplied to the inside of the cover sheath 623 via the suction tube 701,suction base 700, and channel coupling member 700A. The liquid can bejetted out through a distal opening 602 a of the insertion-unit sheath602 over the lumen of the insertion-unit sheath 602, and perfused to aregion to be treated.

The ultrasonic incision/coagulation system having the foregoingcomponents provides the advantage described below.

Specifically, in this embodiment, the roller pump 723 is driven fortreating a living tissue ultrasonically. Thus, physiological saline orthe like is supplied from the perfusion tank 724 over the perfusionchannel lying between the insertion-unit sheath 602 and prove 625 by wayof the perfusion tube 701. Assume that a living tissue is clamped by thestationary blade 629 that is the extremely distal part of the prove 625and the movable blade 641 and then crushed by ultrasonic vibrations. Inthis case, blood or a fatty tissue can be prevented from flowing betweenthe insertion-unit sheath 602 and prove 625. At this time, the inflow ofblood or a fatty tissue can be prevented by the flow of physiologicalsaline or any other perfusive liquid supplied over the perfusion channelcreated between the insertion-unit sheath 602 and probe 625. A rise inthe impedance of the probe 625 can be suppressed. Besides, smoothultrasonic driving can be realized but the resonant frequencycharacteristic will not be disordered. Eventually, deterioration in atreating ability can be prevented.

Furthermore, it can be prevented that when the probe 625 of theultrasonic incision/coagulation system is vibrated ultrasonically, theprobe 625 oscillates at any frequency other than a predeterminedfrequency. It can therefore be prevented that an unbearable abnormalsound occurs during ultrasonic treatment. Consequently, high-efficiencyultrasonic driving can be realized, and deterioration in a treatingability can be prevented.

Moreover, regions surrounding the ultrasonic treatment portion can becooled efficiently with physiological saline or any other perfusiveliquid jetted out over the lumen of the insertion-unit sheath 602. Acoagulated range of a living tissue can be confined to an operator'sintended area. This contributes to improvement in maneuverability and adrastic decrease in the time required for a surgery. Nevertheless, itwill not take place that a nervous tissue is injured thermally.

Furthermore, for treating a living tissue ultrasonically, the livingtissue is clamped by the stationary blade 629 that is the extremelydistal part of the probe 625 and the movable blade 641. The livingtissue is crushed by ultrasonic vibrations. At this time, the suctionpump 716 is driven in order to suck the crushed living tissue over thethrough hole 710 of the probe 625 and discharge it outside. The livingtissue sucked into the through hole 710 of the probe 625 can thereforebe discharged smoothly. Consequently, a rise in the impedance of theprobe 625 can be suppressed and high-efficiency ultrasonic driving canbe realized. Eventually, deterioration in a treating ability can beprevented.

Moreover, the function of perfusion or suction may be used incombination with ultrasonic coagulation in order to coagulate or incisea living tissue of an intended region. In this case, the sole employmentof the handpiece 601 of this embodiment makes it possible to carry out aseries of work steps uninterruptedly without the necessity of changingtreatment appliances. The series of work steps includes steps of peelingand exposing the living tissue, emulsifying it, crushing it, sucking it,and then discharging it to outside the body. Incidentally, when theseries of work steps is carried out in order to coagulate or incise aliving tissue, if a plurality of treatment appliances must be changedduring surgery, it is annoying. The employment of the handpiece 601omits the annoying work of changing treatment appliances during surgery.Consequently, the maneuverability of the ultrasonic incision/coagulationsystem can be further improved and the time required for surgery can bedrastically shortened.

Moreover, in this embodiment, the ring-shaped channel coupling member700A is fitted on the holding-unit sheath 603 of the handpiece 601 to beturnable. The perfusion base 700 is projected from the channel couplingmember 700A. The position at which the perfusion tube 701 and perfusionbase 700 are coupled to each other can be shifted to any position alongthe circumference of the holding-unit sheath 603. The perfusion tube 701can therefore be moved to a position at which it will not interfere withuser's manipulations during ultrasonic treatment. Consequently, theease-of-use of the handpiece 601 can be further improved.

Moreover, the twenty-ninth embodiment of the present invention will bedescribed with reference to FIG. 85.

In this embodiment, the handpiece 601 of the ultrasonicincision/coagulation system of the twenty-eighth embodiment has beenmodified as described below.

Specifically, the perfusion base 700 is projected from theinsertion-unit sheath 602 of the handpiece 601 of the twenty-eighthembodiment. An end of the perfusion tube 701 is coupled to the perfusionbase 700. The other components are identical to those of the handpiece601 of the twenty-eighth embodiment. The same reference numerals will beassigned to the identical components. The description of the componentswill be omitted.

In this embodiment, the holding unit of the handpiece 601 has a simplerstructure than that of the handpiece 601 of the twenty-eighthembodiment. Specifically, in the twenty-eighth embodiment, thering-shaped channel coupling member 700A is fitted on the holding-unitsheath 603 of the handpiece 601 to be turnable. The perfusion base 700is projected from the channel coupling member 700A.

The thirtieth embodiment of the present invention will be described withreference to FIG. 86.

In this embodiment, the handpiece 601 of the ultrasonicincision/coagulation system of the twenty-eighth embodiment, has beenmodified as described below.

Specifically, the distal part of the stationary blade 629 is formed as acurved portion 629 a that is curved obliquely relative to the centerline of the stationary blade 629. The stationary blade 629 is theultrasonic treatment portion 626 that is the extremely distal part ofthe probe 625 included in the handpiece 601 of the twenty-eighthembodiment. The distal part of the movable blade 641 is formed as acurved portion 641 a curved in the same direction as the curved portion629 a of the stationary blade 629. The other components are identical tothose of the handpiece 601 of the twenty-eighth embodiment. The samereference numerals will be assigned to the identical components. Thedescription of the components will be omitted.

In this embodiment, the distal parts of the stationary blade 629 andmovable blade 641 of the handpiece 601 are formed as the curved portions629 a and 641 a respectively that are curved in the same direction. Thisis helpful in facilitating the work of clamping or peeling a livingtissue by means of the stationary blade 629 that is the extremely distalpart of the probe 625 and the movable blade 641.

The thirty-first embodiment of the present invention will be describedwith reference to FIG. 87.

In this embodiment, the handpiece 601 of the ultrasonicincision/coagulation system of the twenty-eighth embodiment has beenmodified as mentioned below.

Specifically, a notch 731 that is a notched portion of the outercircumference of the probe 625 is formed in the distal part of thestationary blade 629. The stationary blade 629 is the extremely distalultrasonic treatment portion 626 of the probe 625 included in thehandpiece 601 of the twenty-eighth embodiment. The other components areidentical to those of the handpiece 601 of the twenty-eighth embodiment.The same reference numerals will be assigned to the identicalcomponents. The description of the components will be omitted.

In this embodiment, the work of resection can be carried out byimmobilizing a living tissue using the notch 731 of the stationary blade629 of the probe 625 included in the handpiece 601. This results in afurther increase in the number of kinds of treatments that can beconducted by employing the handpiece 601 of this embodiment. Thefrequency of the work of changing treatment appliances during surgerycan be further reduced. This contributes to further improvement inmaneuverability and a drastic reduction in the time required forsurgery.

In the present invention, it will be apparent that a large range ofdifferent embodiments can be formed on the basis of the inventionwithout any departure from the spirit and scope of the invention. Thisinvention will be limited to the appended claims but not restricted toany specific embodiments.

1. An ultrasonic incision/coagulation apparatus comprising: anultrasonic transducer for generating ultrasonic vibrations; a probehaving conductivity and extended in an axial direction, the probe beingoperatively coupled to the ultrasonic transducer to allow transmissionof ultrasonic vibrations generated by the ultrasonic transducer; a clampmember having conductivity and disposed to be operable to open and closewith respect to a distal end section of the probe to hold a livingtissue between the clamp member and the distal end section of the probeto incise or coagulate the living tissue; an operating handle adapted tooperate opening/closing actions of the clamp member; a transmissionmember for transmitting an operation amount of the operating handle toopen/close actions in accordance with the operation amount occurring atthe clamp member; and a high-frequency power supply which iselectrically coupled to the probe and the clamp member to performtreatment by high-frequency current to the living tissue.
 2. Theultrasonic incision/coagulation apparatus according to claim 1, furthercomprising electrically insulating means for electrically insulating thetransmission member and the probe from each other, and for electricallyinsulating each of the transmission member and the probe from theoutside.
 3. The ultrasonic incision/coagulation apparatus according toclaim 1, further comprising a connector provided to the operatinghandle, the connector being provided to be electrically connectable tothe high-frequency power supply and being electrically connected to atleast one of the probe and the clamp member, wherein the high-frequencycurrent from the high-frequency power supply is supplied between thedistal end section of the probe and the clamp member via a living tissueheld between the distal end section of the probe and the clamp member toallow incising or coagulating the living tissue along a longitudinalaxial direction of the probe.
 4. The ultrasonic incision/coagulationapparatus according to claim 3, further comprising: a probe insertionchannel through which the probe is inserted, the probe insertion channelbeing disposed in an insertion unit for insertion into a body cavity;and an electrically insulating portion disposed on an innercircumference surface of the probe insertion channel, at a junctionportion between a proximal side section of the probe insertion channeland an ultrasonic transducer housing for storing the ultrasonictransducer.
 5. The ultrasonic incision/coagulation apparatus accordingto claim 3, further comprising a counter electrode board connected to afeedback portion-side of the high-frequency power supply to allowsupplying the high-frequency current from the high-frequency powersupply between one of the probe and the clamp member and the counterelectrode board, or between both of the probe and the clamp member andthe counter electrode board, via a living tissue.
 6. The ultrasonicincision/coagulation apparatus according to claim 5, further comprising:a probe insertion channel through which the probe is inserted, the probeinsertion channel being disposed in an insertion unit for insertion intoa body cavity; and an electrically insulating portion disposed on aninner circumference surface of the probe insertion channel, at ajunction portion between a proximal side section of the probe insertionchannel and an ultrasonic transducer housing for storing the ultrasonictransducer.
 7. An ultrasonic incision/coagulation apparatus comprising:an ultrasonic transducer for generating ultrasonic vibrations; a probeextended in an axial direction, the probe being operatively coupled tothe ultrasonic transducer to allow transmission of ultrasonic vibrationsgenerated by the ultrasonic transducer to a distal end section; a clampmember having conductivity and disposed to be operable to open and closewith respect to a distal end section of the probe to hold a livingtissue between the clamp member and the distal end section of the probeto incise or coagulate the living tissue; an operating handle adapted tooperate opening/closing actions of the clamp member; a transmissionmember for transmitting an operation amount of the operating handle suchthat opening/closing actions in accordance with the operation amountoccur at the clamp member; and a high-frequency power supply which iselectrically coupled to the clamp member to perform treatment byhigh-frequency current to the living tissue.
 8. The ultrasonicincision/coagulation apparatus according to claim 7, further comprisingelectrically insulating means for electrically insulating thetransmission member and the probe from each other, and for electricallyinsulating each of the transmission member and the probe from theoutside.
 9. The ultrasonic incision/coagulation apparatus according toclaim 7, further comprising a connector provided to the operatinghandle, the connector being provided to be electrically connectable tothe high-frequency power supply and being electrically connected to atleast one of the probe and the clamp member, wherein the high-frequencycurrent from the high-frequency power supply is supplied between thedistal end section of the probe and the clamp member via a living tissueheld between the distal end section of the probe and the clamp member toallow incising or coagulating the living tissue along a longitudinalaxial direction of the probe.
 10. The ultrasonic incision/coagulationapparatus according to claim 9, further comprising: a probe insertionchannel through which the probe is inserted, the probe insertion channelbeing disposed in an insertion unit for insertion into a body cavity;and an electrically insulating portion disposed on an innercircumference surface of the probe insertion channel, at a junctionportion between a proximal side section of the probe insertion channeland an ultrasonic transducer housing for storing the ultrasonictransducer.
 11. The ultrasonic incision/coagulation apparatus accordingto claim 9, further comprising a counter electrode board connected to afeedback portion-side of the high-frequency power supply to allowsupplying the high-frequency current from the high-frequency powersupply between one of the probe and the clamp member and the counterelectrode board, or between both of the probe and the clamp member andthe counter electrode board, via a living tissue.
 12. The ultrasonicincision/coagulation apparatus according to claim 11, furthercomprising: a probe insertion channel through which the probe isinserted, the probe insertion channel being disposed in an insertionunit for insertion into a body cavity; and an electrically insulatingportion disposed on an inner circumference surface of the probeinsertion channel, at a junction portion between a proximal side sectionof the probe insertion channel and an ultrasonic transducer housing forstoring the ultrasonic transducer.
 13. An ultrasonicincision/coagulation apparatus comprising: an ultrasonic transducer forgenerating ultrasonic vibrations; a probe having conductivity andextended in an axial direction, the probe being operatively coupled tothe ultrasonic transducer to allow transmission of ultrasonic vibrationsgenerated by the ultrasonic transducer to a distal end section; a clampmember disposed to be operable to open and close with respect to adistal end section of the probe to hold a living tissue between theclamp member and the distal end section of the probe to incise orcoagulate the living tissue; an operating handle adapted to operateopening/closing actions of the clamp member; a transmission member fortransmitting an operation amount of the operating handle such thatopening/closing actions in accordance with the operation amount occur atthe clamp member; and a high-frequency power supply which iselectrically coupled to the probe to perform treatment by high-frequencycurrent to the living tissue.
 14. The ultrasonic incision/coagulationapparatus according to claim 13, further comprising a connector providedto the operating handle, the connector being provided to be electricallyconnectable to the high-frequency power supply and being electricallyconnected to at least one of the probe and the clamp member, wherein thehigh-frequency current from the high-frequency power supply is suppliedbetween the distal end section of the probe and the clamp member via aliving tissue held between the distal end section of the probe and theclamp member to allow incising or coagulating the living tissue along alongitudinal axial direction of the probe.
 15. The ultrasonicincision/coagulation apparatus according to claim 14, furthercomprising: a probe insertion channel through which the probe isinserted, the probe insertion channel being disposed in an insertionunit for insertion into a body cavity; and an electrically insulatingportion disposed on an inner circumference surface of the probeinsertion channel, at a junction portion between a proximal side sectionof the probe insertion channel and an ultrasonic transducer housing forstoring the ultrasonic transducer.
 16. The ultrasonicincision/coagulation apparatus according to claim 14, further comprisinga counter electrode board connected to a feedback portion-side of thehigh-frequency power supply to allow supplying the high-frequencycurrent from the high-frequency power supply between one of the probeand the clamp member and the counter electrode board, or between both ofthe probe and the clamp member and the counter electrode board, via aliving tissue.
 17. The ultrasonic incision/coagulation apparatusaccording to claim 16, further comprising: a probe insertion channelthrough which the probe is inserted, the probe insertion channel beingdisposed in an insertion unit for insertion into a body cavity; and anelectrically insulating portion disposed on an inner circumferencesurface of the probe insertion channel, at a junction portion between aproximal side section of the probe insertion channel and an ultrasonictransducer housing for storing the ultrasonic transducer.